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i ]� {. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 1 Application is hereby made fo 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. `z-aS --C� JOB ADDRESS AND LOCATION ---------- -- ------ -� ;i�� �c O'wner's Name_ -�� - ---- - --- t�--"�- �- - -- Phone --------------------------- Address ________________ , -- ------- -------------------- -- -- ---------------------------- ----------------- Contractor's Name--Lb--_ '-- A � (�` _ x--4-1 --_- Installation will serve: Residence❑ Apartment House ❑ Commerci I Trailer Court M)--.,Ph.ne--A— ❑ ❑ el ❑ Other Number of living units: -El Number of bedrooms ❑ Number'of baths ❑ ' Lot size Water Supply: Public system ❑ Community system ❑ Private -' Character of soil to a depth of'3 feet: Sand El 'Gravel El Sandy Loam Clay Loam E] Clay ❑ Adobe El Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well./A"� _Distance fr m foundati/n_Y.6�aafe�/ria'�__e' ________ No. of compartments--------- --------,--Capacity_ l� -_-- ize. iquid depth--- - ----- ---- G sspool: Distance from nearest well-----------------Distance from fo ,dation-------------------.Un mg material- --------------- --------------- V ❑ Size: Diameter--------------------------------------Depth--- ------------------ --------------------- ---- i - 'Privy: Distance from nearest well--------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line : _ Seepage Pit: Distance to nearest well---_------------------Distance from foundation____________,______Distance to nearest lot line__________ ❑ -Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth,-------------------------------- ---- Dispo I Field: Distance,:from nearest well_________________,Distance from foundation_.`_��yy - - -- .�•�-'-..,_.�• -- - - —.� ._ .. l(.[_�A______--Distance to nearest lot line-- ------------- -- r_. - -, s Number-of lines-___________ k _ _ __ Lengthofeach line°____-G-_��`---- Width of trench_____,.-�___________ - !i<--- Type of�fi•Iter material__- __ ____Depth of filter material____ c Remodeling and/or repairing'(describe)----------------------------------------- ------------------------------------------------------------------------- ---- -k% ------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- 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 reguiatio of the San Joaquin Local Health District. ---- �--- �4 .. ... _Y = ---------c�------� / i By------------------------------------------------------------ - Tale--- caner and`oi Contractor - - ------ -�-------------- --------------- -- (Plot plans, showing size of lot, location of syste in relation to wells, buildings, etc., must be filed with this application). 1� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- _ y ------------ DATE---j-t-4f1�Y§---------`_ REVIEWED BY --- _ �+-- - - - - -- DATE---- ----- -- -r BUILDING PERMIT ISSUE1��Ti ______ --__ r ) • ----- -- -- �� DATE-------- - -s -- -- --- - - ----- t Alterations and/or recommendations_________________________- ----- ------ W--------------------------------------- ------------- ------ -- �. --- --------------------------------------------------------------------------------------------- -------- ---------- ---------- ------------------------------------------ -- - --L�.___--- ------- -- --- -- -- - -if-/ - - -- - - ------------ - � - --------- J(/� - ---------- ---- ------- --k- PERMIT ---- -- - PERMIT No.-A -3 /---_I--- ISSUED--------------------- �L �7 � �' ------------(Date) FINAL INSPECTION : 7_ilt__- _± - Date--------- �--��'----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-4-2M 9-50 W=fb39 �jr .