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f <br /> APPLICATION FOR SANITATION PERMIT <br /> ' (Complete in Duplicate) <br /> +✓ Z 10 <br /> F <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----------2E_52_------ r_3,atoa--- v_.�,_--Stk`_n-.,---Calif .---------- <br /> •--------------------------------- <br /> Owner's <br /> -----------------Owner's Name------k�lr----And-- --:7-oI1n--1'-.---OSx'le-y-r----412 -E-'---:Ax'Cad�-------------- --------Phone----B-$125-------------- <br /> Address-----.- -------------------=-------------- --- - --------------------------•---•---------------•-------•------- <br /> Contractor's Name-------D-e-2 a-$-_ ept.io----T&nk-_S4nrice--------------------------------------------------------------- Phone----3-3955--------- <br /> Installation will serve: Residence Ij Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: :-[I Number of bedrooms 2 Number of baths 1:1 Lot size-------75x---}44--------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [2 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [k Clay ❑ Adobe❑ Hardpan ❑ <br /> k- 5 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:— <br />= (No septic tank or cesspool permitted if puublirr sewer is available within 200 feet.) <br /> E Septic Tank: Distance from nearest well-----j.5"__=-Distance from foundati0n__-_:3_ !--____.Mafefitl_____F—ArtUttmg_- � <br /> etsC - ,10-0-g #_1_Size-----JI24--:-X.4_'_-----Liquid depth--------------------------"eXist� of comartm ______-______________- <br /> steel)Di9t§ rom nearest welL_______________Distance from foundation--------------------Lining ma+erial__-____-____---__--_---_----__-----__Cesspoo <br /> . <br />' [] Size: Diameter --------------- Depth - <br /> ce from nearest building---- <br /> Privy: Distance from nearest well-------------------------------------------------Distan ' <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> i <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- a� <br /> Disposal Fie Number of ---------------Lining material-----------------------Size Diameter--------•---------------Depth ------------ ---------- -- 4 <br /> � <br /> p Field: D _istance from nearest well ----.Distance from foundation-----5------------Distance to nearest lot line _ <br /> Length of each line 1 <br /> &0' ?" �p � - -- p �;-..-- �- ---���---Width of trench---= ---- -------- � <br /> [�,eX 3.st� umber of lines--��16-t-1Y�--------- '---,. , <br /> Type of filter material-j_ - -__ra_ _De Depth of filtermaterial____-( !------___ <br /> Remodelin 'and/or regairin (describe):--------------- pairin - -E)___-FT--- --r"il1-{fir'-------- - .� ----A- --•- ' -- p.1. <br /> i � �'N �!' w t•ems-. <br /> �-�-�---t_n!. - <br /> v <br /> El � � 1 . 1 V_r�l <br /> F -------- 02 1 <br /> e Ja�s <br /> -W_j J `- Q A ------- -- d k <br /> I hereby certify that I have prepared 4his application and that the work will be done in accordance with San Joaquin County " <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) Delta -ept_lQ_'_1'an er_vi7 - --------- ------ ------------------------------------------------------(Owner and/or Contractor) <br /> By:--------lerr-Y--k,iarthan-- - ------ ---- ----------------------------(Title)--ow er Nigh',----------------------------- <br /> (Plot plans, showing size of lot, location of s 'e elation o wells, bui(dings, etc., must be filed with this application). 1 <br /> d sr.• <br /> FOR DEPARTMENT USE ONLY y s <br /> c 4 <br /> APPLICATION ACCEPTED BY---------------- DATE----- = : <br /> REVIEWED BY-----------------=--==---------------------------------- -- - -------- ----------------- <br /> ------ DATE------ f ` ------------------------ <br /> YBUILDING PERMIT ISSUED:%*-'•---------------------------------------;--------------- ------------------------------- DATE----------------,---------:, ------------------ ------------- <br /> b_ :Alterations and/or recommendations:--.--- ----V_,Q"a---- I` x. = '{'_l _17_�------------------------------------------------- <br /> D � <br /> --------------------------- ---------------•-•-----------------------------•------------------------ ----------- ------------------------------- - --- ------- ---------- <br /> 4 <br /> --------- <br /> --------------------------- -- ---- <br /> PERMIT -------- ISSUED------- ------------ Date] FINAL INSPECTION BY-----------------------41-9- ------ <br /> Date------ <br /> ----- <br /> Date------ --------•---------- -� -� ---- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton; California <br /> r. ES--9-2 M 9.50 W-1639 �'+ <br />