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f APPLICATION FOR SANITATION PERMIT (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----------20.��---Brietal- Aver---�t-D_c�_'�t�ri--------------------------- - Owner's Name-------------------------------------------A'---0 ----RESERG` Phone ." $ Q Address----------------------------------- ,Q53__Bri_�;to] Ave,----5'Ga_01, -Qu------------------------------------------------------------------------------ Contractor's Name_.------------------- -------------- Phone----27'07-------------- ----------------�x---�-*---P��x'3.�h--s�---Soni-t---Inc-�----------------•- Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ElOther ❑ Number of living units: KI Number of bedrooms 21 Number of baths [I Lot size----10-0-1X1Q9_!--------------------------------- Water Supply: Public system XJ Community system ❑ Private ❑ { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: LA (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q Septic Tank: Distance from nearest well____NQe__Distance from foundation-.__- ._______Material_____ ___ __ i.c3�_________________ ; No. of compartments-------------z_----------Capacity---$ ---G-.---Size5E3E1-C36I1X-6-E1 Liquid depth_--5211----------- -- Cesspool: Distance from nearest well-----------------Distance from foundation -------------------- material_______________________-___________-_. i ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- .Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__________- ___________----------------- ❑ Distance to nearest lot line___________________________________ ______ _ Seepage Pit: Distance to nearest well-Y-0110--______Distance from foundation___1Q_1______-_.Distance to nearest lot line--- QS_______ Number of pits-----1--------------Lining material----G`----0---R1°iSOk: Diameter--__J3..___.------.Depth_--12------—--------------- Disposal Field: Distance from nearest well n! --___.Distance from foundation_____�Q_!------Distance to nearest lot l n{1�-4_�_____--tNumber of lines---------1-----------------------Length of each line--------5Q- ---------------Width of trench--------------�' ---------------- { Type of filter material_;___lv�"---Rk___Depth of filter material____ __________ Re o�ieling a�d/off a airing. descr'k1'�}:----- • --1~�D-�T__.3.I1.8�a11t3.t1 ]G1_._�-�--.---�-�- tx'- - --Ga�ib---&D -t--y-1--------. .. --- --- . ----- - --- , - - _ t --Ir- .--0.1,010__----�o---------- - f ----- -��-- ------ - - -- -' ---- - ---- ------ --- ------------------- -nt------ ------- ----------------------------•I--------------- ty hereby certify ft I have prepared this application and that the work will be done in accordance with San Joaquin oun ordinances, 5 laws, and rules and regulation of the San Joaquin Local Health District. (D. A• _P __ `4c - 4----Uio"----------'------------------------------------- '----------------0-----------( � Contractor) (Signed) --------------- --- --------- z�� --- Title E 8��.MP— -Q-r--------------------------------- B • -- - ---------- (Title) (Plot ans owing size of lot, location of syst in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ::- DATE 14------ REVIEWEDBY------------------------------------------- ---------------------------------------------------------------------- DATE �� BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------- /------- -------------------------- - Alterations and/or recommendations------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ' ----------------•------------•---------- ---------------------------------- ------------------------------------------------------- ---------------------------------------------------------------------------------------------•----------------------------------------------------- ------------------------------------------------------------------------- ------------------•-•---------------------•-•---------- -- - - - ----- ------------ ----•----------- �' °.Z -�----------------------- _ __ ISSUED_____� --��--�-----------(Date) FINAL INSPECTION BY:_____�'d�_____--------------------------------------- -2/sol/ ___ _ ___ • PERMIT Na,____-� -�-_--- Date-----------------2�- r� `� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639