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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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 49. JOB ADDRESS AND LOCATION____ ------------C_A�----------ez"--k----------!Zt/----------------------------------------------- , rid_ ------�_� ------------------------Aij Owner's Name----- -- 1 ------------------ Phone------------------------------------ 0 Address-----/1 �1./ + t �� I--( -./?//----------1 [ ------ i so 1� C�� 7 Contractor's Name--.-�--� -------- A-__RRL,5_f ------4C TAI t ----- Phone f = / --- Installation will serve: Residence ;& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: [t Number of bedrooms 11 Number of baths 0 Lot size_____---x j__��. _�-------____________ Water Supply: Public system W . Community system ❑ Private ❑ I Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam El Clay Loam ❑ Clay El Adobe Hardpan ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwel __"".':____Distance from foun tion_ /__________.�Material_ /1��_�4�Te-_____ No. of compartments___7--V-V-V-------Capacity ._.T!_.DtLiquid depth -- ------- Cesspool: Distance from nearest well____----_--------Distance from foundation------------------- Lining material____________.____________________f__. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: ---------------------------------------- -:Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------.------------ ❑ Distance to nearest lot line------------------------------------------------ - f Seepage Pit: Distance to nearest well----------------------Distance from foundation----------- ___-___.Distance to nearest lot line_________________ 17Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------... ----.-_-- Disposal Field: Distance from nearest well__:-_'------ from foundation__/P__=_-------Distance toynearest lot line-Ya--- Number of lines____-_�^.--________Length of each line____��_�____ Width of trench-_1+__1 1_________________ qq VT---- Type of filter material__- Depth of filter material---- Remodeling and/or repairing (describe):------ - --------------------------- = - ----------O-----W--------------- ---- --- - I hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, S e aws,pd rules and reg lations of the S Joaquin Local Health District. f (Signed).. t s r f ��c (Ow�nerandl/or C ntractor0y:------------- -- ---- -- ------- ------------- ------------- -- - - - -----------------------(Title)------- ---------- - - ------------------- (Plot plans, showing size of lot, location of system in vela+ n to wells, buildings, etc., must be file ith this application]. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------�l--�--/---- IDATE------ -------------- } vV _ REVIEWEDBY---------------------------------------------------------------- -----------------------------=--------------------- DATE--=- ---'- =--`_-- -------------------•-------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- :------------------------------------------------------------------------ --------------------------------------------------------------------------.... ------------------------------ ---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No. -0-1 ISSUED------------------------------------------(Date) FINAL INSPECTION BY:-------- ---------------------------- Date--------------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT # 130 South American Street Stockton, California ES--9-2M 9-50 W-1634