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few 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 No..549. 1711 JOB ADDRESS AND LOCATION__ -= _- �____t! -cX� -------- - `--- Owner's Name-Z272 �C�. " '=---------------- ------------------------------------------- Phone `�--- 71 Address--_- ;.� ¢---� - ----A,- --------- ------------------------------------------------------------------------------ --- ---- ----- ---- --- -- ---- Contractor's Name_ __:. �J _ Phone__= ""' �'- - --- ------ - --= - --------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial L] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '[i] Number of bedrooms Nurriber of baths ] Lot size____1_ _d _� _ _----------------- ____ Water Supply: Public system ❑ Community system ❑ Private �- Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ElClay Loam [IClay ❑ Adobe V' Hardpan El TYPE OF INSTALLATION AND SPECIFICATIONS: t ?(No septic tank or cesspool•permiiQ if public sewer is available within 200 feet.) � L�^;1.3�',��Li"uid ode th__-! Septic Tank: Distance from nearest well--7-- from foundation____�2_-------Material____ ________________ No. of compartments--------- Capacity------� �-----Size�"3 _ q p +�--------- Cesspool:," Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F1 t Size: Diameter ------------------------------------Depth---------- ------------------------------------- �l Privy: Distance from.nearest well_______________ _______________________---__---Distance from nearest building------------------ vv ❑ : Distance to nearest lot line_-__-_________________________________________ Seepage Pit: Distance to nearest well_____: _`__Distance F. fromfoundation---- -.Distance to nearest lot line __-te l_=_____ Number of pits_______/ --- - material __________.Depth___Lining _ n --Sze: ameter A _ ►- Distance t lot line_____ to neares ___ Disposal Field: Distance from nearest wbll_____7Q_*`_.Distance from foundation_____ _ _ _r____ • Number of lines________________ _ --------------`-Length of each line------CQ f............Width of french-----�Z4r----_--------------- Type of filter material-/ .! _•-Depth of filter material------ �_ Remodeling and/or repairing (describe)---------- ----------------------------------- ---------------------------------------•---------------------=----••-=------------------------------- 1 --•---'------------------------------------------------------------------------------------ --- - ------------------------------ ----------------------------------- ------------------------------------------------------------------- - I hereby certify that 1 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. I�. (Signed) � ---------------------------------------------------------------- --- .{wane--ad/or Contractor) BY: _ P /? --------------------------=----------------- --------------------[Title : -------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- DATE I�--------------------- I - -------- - ----------------- REV11 WED BY ----------- ---------- -��:: ,,_. --------------------------------------------------------- DATE------ ��---��---- ------------------------ BUILDINGPERMIT ISSUED----------- ----------------------------------------•-------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No.__�6_1------------- ISSUED-----(/____�__ -___-__ -------.--{Date) FINAL INSPECTION/BY:-&- ' Date__L/.-� /�1---------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT // 130 South American Street Stockton, California ES-9-2M 9-50 W-1639