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APPLICATION-FOR SANITATION �PERMIT Al� '(Complete in•Duplica+_e]" �[J Applicafion is hereby made to the San Joaqutn�LocaI HealfKbistrict 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---------- Owner's ` A:.=_. _ '� �1 +I2yC�� caI ier�+ Owner's Name----- �'- 17r17._ - -----•------ ------------ ------------------------------------------------------------------------------- Phone-----?'4 39 Address------------ 50.21 --- ------------------------------------------------------------•- --------------------------------------------- Confractor's. Name_______--_R-f A : 1'arx a. 1c�ns.....-Znc.------------------------------------------------------------ Phone_ ---��-85.9.7 ------------ �j Installation will serve: _Residence ❑ Apartment House ❑ . Commercial l ❑ Trailer Court ❑ Motel ❑ Other;�]G��"p Number of living units: ® Number of bedrooms ® Number of baths Lot size_____ 0"�X__ 148 ' A�+� Wafer Su I•• Public system ® Community system Suppl'- Y Y ❑ Private jj `Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Har �] dpan El OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if publi�prer is available within 200 feet.) ,. I Septic Tank: Distance from nearest well---- Q------•Distance from foundation-------- �3_!___-Material__��n"CrE�e _circ �� V IL No. of compartments__ - t� P Y ze---i�3-.�'_C_------'�';;T��e_Ligwd depth----�r-2--------------- Cesspool: Distance from' nearest well______-_______-_Distance from foundation_" _ Lining material_"_______-______-" ❑ Size: Diameter-------------------------------------Depth----------------- --------------- (r , 'Privy: Distance from nearest well-------"--------------------" __ :_Distance from nearest building Distance to nearest lot lino_--------•---____-- ""-_-- g--------------------- El -- --------------""-- ----------------------- eepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest )of line_________________ ❑ Number of pits__ __----------_Lining material-------------•---------Size: Diameter__-________"__ -------.Depth--------------------------------- .Disposal-Field: _.Distance from nearest well ,kS]1_,_,_,Disfance,from�.ound Number ati C3. ! �_ r -- Pisfance-to nearest_]o.�l�e.___ 5 ___ q it fines.________•,---------------------Length of each line--_4 -- _- idth�of trench_----- - E Type of filter ------------------- ter material__`__l ..---R'�"Depfh of filfer materia-------- -_--ander Remodeling and/or repairing (describe):_________•-"____"" ----- --7-------- ---- --------- --- -- ------------------------------------------------------ - ---------------------------------------- ----------------------------------------------------------- ----------------------------------------------- { 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. (Signed)------- '� 2I ,. _ T_I-� � -- --------------------------------- -------------- � + `C�,� Contractor) f ---- -- --- - -- ------ ------ -------{Title)---E-5ls -i 4 ' -i of PI s, showi lie-of lot, location of system in r afion fo wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______-_ _ -------------- REVIEWED :_/ -"""_ r— F,3,-- ---------------------------- ------------------ DATE---------- - - R EVI EW EQ BY -- -------------- = ----------------------------- QATE--------------G�.J�-------------------------- -------- BUILDING PERMIT ISSUED - ------------------------- { ---------------- ------ DATE----------------------- Al+erations and/or recommendations:___-.-"""_"___-"""____-" ""-�-"""--"""--"-�-"" """------" --------------------------- -------------------------------------------- ------------- -------------------- -�- L ---------_=1_.`� �-sr� --- - --------- ---- ------------------------------------ ---------------------------------------I----------------- ---- ------- ------------------ PERMIT No---------- -- ----""-- ISSUED- ___-- -----5' ------Date) FINAL INSPECTION BY:_---- ---------------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9 -2M 9-50 W-1639 Stockton, California