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7� '% K I R 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 ! ► c"'ol,4`-aJ4'.N-------------- -------------------------------- Owner s Name �' ------ --------------------------------------------- - Phone 2 r!- � ------------------------------------- Address------`�`�-�-'_�__....-��°----s4..7.� ,.- - - Contractor's ------ --' �`'.. ' - ` ~ ._.. Phone = Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai4er Court ❑/ Motel El Other Els [ Lot size____;l_5�________ _____ ____________________________ Number of living units: Number of bedrooms 1A.- Number of bath Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ f TYPE 05 INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) Septic Tank: Distance from nearest well------------------ from foundation__.-------.--------.Material _______________--__-________._____�_,__ '___`_`- ❑ No. of compartments---------------{--------Capacity-------------------- Size----•-----------•-•----------•--Liquid depth-----------'--------------- 1ZN1 i /___________-Distance from foundation___________________.Lining material------------------------------------- Cesspool: distance from nearest well . . ❑ Size: Diameter------ ---------------------------------Depth--------------------- -- --- -------------- .Privy: Distance from nearest well--------------------------------------------e�--Distance from nearest building------------------------------------------- n Distance to nearest lot line------------------------------------ --- ---- `Seepage Pit: Distance to nearest well____10a__---_Distance from foundation______A�____.Distance to nearest lot line_.:________�:-- Number of pits Diameter.-;7X material_U"�__ ___Size: Diameter._;7X--------------- Depth r_%_' °�--- rl rr Disposal Field: Distance from nearest well_______________-Distance from foundation__________________-Distance 4G nearest lot line_______._._______ 4' ❑ Number of lines------------------ ------Length of each line-----------------------------Width of trench G 4 Type of filter:material________________________Depth of filter material_:_________________-__ .000 00:0 --- Remodeling and/or repairing (describe}: -LU .f '�' � �'=: = ---- ------` -a` I _ - r ---------------- --------------------------------------------r--------------------------------------------------------------•------------------------------- hereb certify tha+-I,have prepared this application and that the work will be done in accordance with San Joaquin County :.. ordinances, to laws, and ul s and regulations of the San Joaquin Local Health District. r ---- --- (�/or Contractor) , (Signed)- ----'- -- ------- ------ --------------- --------- - _ ----- Title = By� -: _ ----------------------------------------------- ---------- ---------- { } (Plot.plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY ACCEPTED BY = ` ------------------------------- APPLICATION i. --------- --------------------------- DATE. , REVIEWED BY-------------------------------------°�' - rte---- ------ -------------------------- DATE-----------�=----=---n---------------------------- --------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------w------------------------- ----------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------- ------------------ -•--------------------•--------------------------------------------- ----------------------------------------------------------------- ----------------------------------------- f PERMIT No.._6--- -------------- ISSUED_._ _ -- -- - 4-7�---•--(Date) FINAL INSPECTION BY:---------vo---A--------------- d------------------- b-�- YS r Date---------------------------------- .. ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9---2M 9-50 W=1639