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_ � (1 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application -is'hereby made to the-Sah 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_ __ -17 :S _�______= L~ � � r ` / - ------ Owner's Name---------= /17-C�--- I -----------UL �-------------------------------------------------------- PhoneE��G''�f Address--...-----------------7f 5 -- =�--C' _u—RRK- —�-------------------- ------------------------------------------------------------------------- Contractor's Name----- /_5- ------------� f - T� t Phone__/___ �? Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ,Motel E] Other s�❑ Number of living units: V) Number of bedrooms t3 Number of baths a Lot size-__I��G_'__`__�--- �_______________ 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic Tagk: Distance from nearest well_.`_.__y__^�. Distance from foundation___________________.Material------------------------------------------------- 1.#-- No. of compartments ----CapacityN, __--Size-------------------------- ---Li Liquid depth ts I N 9� p -s 4 -- g p ----- Cesspool: Distance from nearest well________________Distance-from foundation------------------- Lining material__________________________________. ❑ Size: Diameter--------------------------------------Depth--k=------------------------------------------------ Distance from nearest well_______________________ ---------, Distance from nearest buildin :Privy: � ----- , 5 -------------------------------------- ❑ Distance to nearest lot line----------------------------- -- Seepage Rif: Distance to nearest well_WOlV�____Distance�from foundation___/_a......... _Distance to nearest lo_ line-�-------------- -Disposal Field: Disfance`from`nearest-well7fff jfz—Distance from foundation__.3-----------Distance to nearest lot line____•________ 1 Number of lines__0 __rr__ _ _Length of each 1ine_ ___:_____i�:__.Width of trench__ `_71 ------------------- r pp Type of filter material 66K Depth of filter material____-,�,--------- -Remodeling and/or repairing (describe):-___,______________�/ _P_j)_!r,7PM-_______/___U______�1 _`s7/_!v6'_____..: _l } -------°--....�-- - --------------------------------------- =5x-- n �-------------------------------------------- . ,� ± s -------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepareVfhnit-a plication and fha# the work will be done in accordance with San Joaquin Countyordinances, State and rules and reof the San Joaquin Loc ealth District. r.ur �rw, .a... .tel • - � 6 (Signed) 4 -------= ---(Owner jnd/ Contr cfor) 91 -+S t , By -------------- -- --- -- --- ---------�--��' "__- - '-------------------(Title)---------- -- - --- ----- - - - -- -------------- (Plot plans, showing size of lot, location of system in relatio to wells, buildings, a#c., mus# be filed w' h this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY - ----- DATE------ a - REVIEWED BY--------------------`,------- r { J BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- Alterations and/or recommendations:---------------------------------------- ` --------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------•--------------:---------------------------------------------------------------------------------------------- 'f ' 4 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- -- -- ---- f PERMIT 'No,-_r✓'KQ--------- ISSUED------- ,' -- ------(Date) FINAL. INSPECTION BY:--------_- --------- -_-------------------------------------- Date-------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street k' Stockton, California ES-9-2M 9-50 W 1639 r