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f APPLICATION FOR SANITATION PERMIT ' (Complete in Duplicate) +✓ Z 10 F 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----------2E_52_------ r_3,atoa--- v_.�,_--Stk`_n-.,---Calif .---------- •--------------------------------- Owner's -----------------Owner's Name------k�lr----And-- --:7-oI1n--1'-.---OSx'le-y-r----412 -E-'---:Ax'Cad�-------------- --------Phone----B-$125-------------- Address-----.- -------------------=-------------- --- - --------------------------•---•---------------•-------•------- Contractor's Name-------D-e-2 a-$-_ ept.io----T&nk-_S4nrice--------------------------------------------------------------- Phone----3-3955--------- Installation will serve: Residence Ij Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :-[I Number of bedrooms 2 Number of baths 1:1 Lot size-------75x---}44--------------------------------- Water Supply: Public system ❑ Community system ❑ Private [2 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [k Clay ❑ Adobe❑ Hardpan ❑ k- 5 TYPE OF INSTALLATION AND SPECIFICATIONS:— = (No septic tank or cesspool permitted if puublirr sewer is available within 200 feet.) E Septic Tank: Distance from nearest well-----j.5"__=-Distance from foundati0n__-_:3_ !--____.Mafefitl_____F—ArtUttmg_- � etsC - ,10-0-g #_1_Size-----JI24--:-X.4_'_-----Liquid depth--------------------------"eXist� of comartm ______-______________- steel)Di9t§ rom nearest welL_______________Distance from foundation--------------------Lining ma+erial__-____-____---__--_---_----__-----__Cesspoo . ' [] Size: Diameter --------------- Depth - ce from nearest building---- Privy: Distance from nearest well-------------------------------------------------Distan ' ❑ Distance to nearest lot line------------------------------------------------ i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- a� Disposal Fie Number of ---------------Lining material-----------------------Size Diameter--------•---------------Depth ------------ ---------- -- 4 � p Field: D _istance from nearest well ----.Distance from foundation-----5------------Distance to nearest lot line _ Length of each line 1 &0' ?" �p � - -- p �;-..-- �- ---��---Width of trench---= ---- -------- � [�,eX 3.st� umber of lines--��16-t-1Y�--------- '---,. , Type of filter material-j_ - -__ra_ _De Depth of filtermaterial____-( !------___ Remodelin 'and/or regairin (describe):--------------- pairin - -E)___-FT--- --r"il1-{fir'-------- - .� ----A- --•- ' -- p.1. i � �'N �!' w t•ems-. �-�-�---t_n!. - v El � � 1 . 1 V_r�l F -------- 02 1 e Ja�s -W_j J `- Q A ------- -- d k I hereby certify that I have prepared 4his 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. (Signed) Delta -ept_lQ_'_1'an er_vi7 - --------- ------ ------------------------------------------------------(Owner and/or Contractor) By:--------lerr-Y--k,iarthan-- - ------ ---- ----------------------------(Title)--ow er Nigh',----------------------------- (Plot plans, showing size of lot, location of s 'e elation o wells, bui(dings, etc., must be filed with this application). 1 d sr.• FOR DEPARTMENT USE ONLY y s c 4 APPLICATION ACCEPTED BY---------------- DATE----- = : REVIEWED BY-----------------=--==---------------------------------- -- - -------- ----------------- ------ DATE------ f ` ------------------------ YBUILDING PERMIT ISSUED:%*-'•---------------------------------------;--------------- ------------------------------- DATE----------------,---------:, ------------------ ------------- b_ :Alterations and/or recommendations:--.--- ----V_,Q"a---- I` x. = '{'_l _17_�------------------------------------------------- D � --------------------------- ---------------•-•-----------------------------•------------------------ ----------- ------------------------------- - --- ------- ---------- 4 --------- --------------------------- -- ---- PERMIT -------- ISSUED------- ------------ Date] FINAL INSPECTION BY-----------------------41-9- ------ Date------ ----- Date------ --------•---------- -� -� ---- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton; California r. ES--9-2 M 9.50 W-1639 �'+