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w APPLICATION FOR SANITATION PERMIT ��, 9 =� .,� (Complete in Duplicate) ' "�" ° Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----40_U.l.0--- erm------ ---Bradf-or d---------------------------------------------------------------------------- Owner's Name------------------------Lo - BeTx' ----------------------------------------------- --------------------------------------------- Phone--;Z-a!-5j--------------- Address-_4- �.�a�__..._211�FHr_adld�rd --------.-.. Contractor's Name------•kpltA------------------------------------------------------------------------------------------------------------------------ Phone--3-3-93,5------------ Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _Other ❑ Number of living units: M Number of bedrooms [a Number of baths a Lot size----------.>r.oxjj.o---------------------------------- Water Supply: Public system 9 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [IK Hardpan❑ \�1�• TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well---------__--__Distance from foundation________ !_-__�.Ma serial_-_--_CEIDEri�--brick-__,_--. No. of compartments-------9---------------Capacity-----a d Size -------3--.x X �iquid'depth Cesspool: Distance from nearest weil-----------------Distance from foundation--------------------Lining material----_-_-_---____----_--_-----____--- E ❑ Size: Diameter--=-•-------------------------------Qepth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------.____-----_.-. . ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_-_--_-_----_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Disposal Field: Distance from nearest well------------------Distance from foundatiq .,------------Distance to nearest lot line----.----___---__ EXI,S TING Number of lines--------Z------------------------Length of each line-------JJ-..---------------------Width of french----7---------------------------- Type of filter material-------------------------Depth of filter material-_---__-__-__-__--_-_- Ins- Al].1ng_-new .'cment-brick septic tank to take Remodeling and/or repairing (describe):----------- A..---- - ..........................---------------- ---------------- -------------------------------- theae Q # --- xin�..waod--dank heoking...uto eeistin� leach_--drain_-kith k ---------$cliso.:-1.1ne-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ---- -------------- ----- --------------------------------------•------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)------------------------Perry_-Wax'th--. - -------- -------- ------------------------------------------- (Owner and/or Contractor) Owaer—Mgr. I By:---------------- p-w' : --- ----- ------------------(Title)------------------- - t (Plot plans, showing size of lot, location ,f system n r at' n to we s, buildings, etc., must be filed with this application). i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- -----------------------------------------------------------,--------------------------------- DATE--:5 ----------------------------------------------- REVIEWEDBY----------------------------- -------------------------------------------------------------------------------- DATE %----------------------------------------�'"' BUILDINGPERMIT ISSUED---------------------------------------------------------------`--------------------------------------- DATE------------------------------------------------------------ -------------------------------------------------------------------- Alterations ---------- ------------------------------------------------ Alterations and/or recommendations:---------------------------------------_--_-----..._- _- -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------t-------------------------------------- --------------.-..--..... - - --------------------------------------------------------------------------- ------------------------------------------------------------------------------ i --------------------------------------------- ----------- - - f r !!// --__-_-- ISSUED------ --�-�- -/� -_--(Date) FINAL INSPECTION BY------------- ---Vim_ -_-.-------------------- PERMIT No -- f Date-------------------1:-.... ---------------- -------------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ` S+ockton, California ES-9-2M 9-50 W 1639