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7? APPLICATION FAR .SANITATION PERMIT ' 4-� t (Complete in Duplicate) `x.-1 0 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_--___----" �is/ ------- -- ----------------------------------------------- --- /G Q e ---- ----•�/�-- ---------------------------- i Owner's Name �� , -,� / ------- -- r_--1------------ -------- ---- ----------------------------- Phone-----�-°-"--j----1.3�-� Address d -�_ -----�---- / '- ---- Contractor's Name"..."._ 0_.I ....---Gly' -------A-�------ -- r� �----------------------------- ` --------- Phone- -------------•------------------ i Installation will serve: Residence ❑ Apartment House ❑ Commercial 2 Trailer Court ❑ Motel ❑ Other ❑ n Number of living units: ❑ umber of bedrooms El Number of baths F-1Lot size-------_ "_.X. C S-0 - f Water Supply: Public system Community system ❑ Private ❑ ! �iCharacter of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam Clay Loam❑ Clay ❑ Adobe❑ Hardpan ❑ h ;TYPE OF INSTALLATION AND SPECIFICATIONS: ' i, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f -,}peptic' Tank: Distance from nearest woll_5�2Distance from foundation------ Material �p -------------- L�f No. of compartments------------ Capacity._/O_4?..... _Size `jr .�{ G� ___Liquid depth__""__`.-" --------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth------------- ----- C ------------------------------ Privy: Distance from nearest'well------------------------------------------------- Distance from nearest building ❑ Distance to nearest lot line ------------------ Seepage Pit: Distance to nearest well----__---------------Distance from foundation--------------------Distance to nearest lot line----------------- F-1 Number of pits---•------------------Lining material-----------------------Size: Diameter Disposal Field: Distance from nearest well_ ---_-_Distance from foundation--------------------Distance to nearest lots line_--- Number of lines--------3__ 1___ __Length of each line_«1 t"� :Co "Width of french""""_ _""-___""""" Type of filter material" -� <�y Depth of filter material-_-_--l �. Remodeling and/or repairing (describe):"------------- __ - ------------- { . �------- --- 1 - - �' --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------- ---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------A hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun y ordinances, State la , and rules and regd tions of the San Joaquin Local Health District, q {Signed]--••_ -" ------------------------(Owner and/or Contractor l By:-------------------------------------------------------------------------- Tale nt - [Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this applica+ion]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- .-� -------------------------------------------------- DATE------------ — - (J . REVIEWEb BY ----------------------------------------------------------- ------------ ----- - , �- " - -------------- ---•--------- ------------ ------------- ---------. DATE_----------------------- - - �--f------------------ BUILDING PERMIT ISSUED - -'-------- ------ Alterations and/or . -------- ---•---------- ------ ------------ DATE--------------------recommendations: _ ------"" """""--�-'---"""----- 1------------------------- --------------------- ---------------------------------------------------- ---------------------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------•--------------" PERMIT No-422K--------- ISSUED____2___ ---- ---------------(Dale) FINAL INSPECTION BY:" ----------- - - --- Date-------- 114, - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street . - _ Stockton, California z; ES--4-2M 9-50 W-1638