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APPLICATION FOR SANITATION PERMIT ` ` VCom lete in Duplicate) \x ( P Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th°,work herein describe , This application is made in compliance with County Or 'nance N . 5 JOB ADDRESS AN LOCATIONV4 td. � ----------------------- �- _ V .730 Owner's Name----�--/ -- --------- -- --�--------�--Wil'==��----• -------------------------------------------------------- Phone --�--- •.- Address 1- ',7 ••----- -------- _ //�� --- r Contractor's Name--- f k...f[.. `I'- Phone-.F" S?._L f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ F„ Number of living units: t Number of bedrooms(, Number of baths [�] Lot size__ /ejP_'YJ.--XSF.._..::. _._..... Water Supply: Public system ❑ Community system ❑ Private;K Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: Dista -from nearest well -- a--- Distance fro dation.___ ___. tenJa�l. .__ _ No f mpartments_._ __._:_ -------Capacity __ _______ ______Size/''�_ ....1'3� -..DLi d th_ Ce pool: istance n well Di a from fouron Lining material......................... ❑ Size: Diameter--_-------_----------------------- epth----------------------------- y. Privy: Distance from nearest well------------------------------------------------- from nearest building..........................._-_______- ' ❑ Distance to nearest lot line_ _____... y-------------- Seepage Pit: Distance to nearest well ......Distance from dfoy�ndation____ -----.Distance to nearest lot line Number of pits... -•. ...-__.__-Lining material_- �__4�'" -Size: Diamet r._�., ..___.._.Depth._...;ZO-`-_---- , 4:, Disposal Field: Distance from nearest well--%#'Q. Distance from foundation----j1-.-__--__Distance to nearest.iof line--. --C Number of lines------------A0-•_jj_. _Length of each line.•. f Width of trench... .`_......_ Type of filter Depth of fimaterial_____��._ __ __Remodeling and/or repairing (describ ) KZ . -.------• G «*' ---------------------------------------------------------------•--------------------------•-----------------------•------•-------------.._-..__-------__-_.--•-----•---------^__---------------------------------_- ..__v,. . I 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). ------------------------------------------------------------ -- (*Now-and/or Contractot _ r BY: - (rifle) - (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). Alt �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ............................. DATE-------•- -----•---' REVIEWED BY ------------------------------------ C �'Tf fb -------------------------------------------------------------------------- DATE-------------------- /--------•------------------•-- BUILDINGPERMIT ISSUED--------•-------------------------------•---------------•------------------------------------------•• DATE-------------------------------------------------------------. Alterations and/or recommendations- ------------ --•--•------------------------------------------------------ ------ ------------- .------7_____________ __ =_..:: : .....................................-------------•-------------------------------•-------------------------••---------...............................................................................---------.•..-•.-... ------------------------------------------------------------------------•----------.--.---------------------------.-----------------------------------...---------------------....--..--....---------------.-----------...- PERMIT No----'_______________ ISSUED.._!}_....;- a_- ______.....(Date) FINAL INSPECTION BY:..__._... ___V_'.--rY----•-__----.__..__-.-___•-- Date--------------••--•-----) 7_Q-'- -.r... SAN -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639