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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Disirict,for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 44. JOB ADDRESS AND/ADCATIP -------- -------- V- -- --------- ---------------- --- .4�� _! f -� _, _ 4 - --------------------- Phone--- ------ -- --------- Owner's Name Address------------__Z&�__ -------- ---------- ----------------------------------------------------------------------------------------------- Contractor's Name------IRr--- ----------q------eD_&At�--------TWC f------- Installation will serve: Residence Apartment House [] Commercial E] Trailer Court El Motel E] Other E] Number of living units: El Number E] Number of beclroom� Number of baths [3 Lot size__A9&_1'__X---A.S.*6 -- --------------- '11:Z C�l Water Supply: Public system Community system ❑ PriWafe E] Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E], Clay Loam E] Clay E] AdobeA Hardpan E] TYPE OF INSTALLATION AND SPECIFlqATIONS: NO% eAN (No septic tank or cesspool perrniffe'tl ifipZiblic sewer=s available wilin-200 feet.) DistAce from nearest well__ Distance --d- ---------------------Material------------------------------------------------- Septic Tank: tance from f6un ation El No. of compartments----------- S, --------Liquid depth------------- -------:---- Capacity____-_j------------------ ize----------------_---- ------------ ,Cesspool: Distance from nearest well___--'____________Disfan46�from foundation_________________ Lining material_____________{;-_____-_------------ El Size: Diameter--- ------------e------------i--Depfh---------------------------------------------------- .'Privy: Disitance from nearest well------------------ --------- -from,lnearest building____________________________ Disfake to nearest lot line____________" --------------------------------- istance from foundation--------------------Distance to nearest lot fine_---___-_________ Seepage Pit: Distance to nearest well----------------S I't - 2D ~f4 'bdr of pits----------------------Linin.g.,;'��t3 im�--------------------Size: Diame+Jr------------------------Deth-------- p -------------------------- El N dfin Disposal Field: Distance from nearest well-_-�.nnn?�!-_Distance from foundation_.�,,24-- ____-Distance to nearest lot lin -------- Number of lines 0 Jl'-_�---- ----------Length of each line-_00 I _____.Width of trench_ _____________________ OV;---------------- x ------- - ____71 --- Type of,filter mateiaI7;F,2,'A0K,_Depth of filter material--/1�7------------ OT-- 29- epair.ing giscribel.,_.- _Av/ Remodeling and/or r (d ------- ------- SFE ----- --- --- ------------------------------------- ---J_4_X� ---------------------------------------------------- ---- --------------------------I------------ ---------- ----------------------------------------1�-------------Z/---------------------------------------------------------------------------------------------I-------------------------------------------;-------------------- -------------------------------------el---------------------------------------------------------------------- ----—---------------------------i-------------------------------------------------------1--------------- �7 - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State f1l , and ules and r g lotions Of the Sa Joaquin ocal HPIth District.) C -rr C tr to (Signed)---------- ----------- ---------- ---- ----- (Owner apcd on c r W, By:----7------------------ --- ------- ;?- - ----- A-------------(Title)---- nZ (Plot plans, showing siz -611 t, location of syste in relation 0 wells, buildings, efc., must be filed with this applicaflon). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY_ ---------------------------------------------- ----------------- ---- --------- ---------------F--------I---------------- REVIEWED BY----------------------- . ---------------------------------------------------------- DATE-------- ;7L�It,---------------------- --;Cp-------------------- BUILDINGPERMIT ISSUED------------- - ----------- --- ----------------------------------------------------------. DATE-------- ��Wl,t%-------------------------------------- Alterations and/or recommendations-------------------------------- ---------------------------------------------------------------------------------I`, ------------------------------------------- ------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- --------------------7------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------I-----------------------1------------------------------ ---------------------- PERMIT No.__ S-Z---ISSUED------- FINAL INSPECTION BY:----- -----(-4---,)- 4�z --- - ----------------- Date------------- q--------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639