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x APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4k Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.E JOB ADDRESS AND LOCATION------------- 0-0 --- !I_U tD � _------------------------------------------------------------------------------------ Owner's Name------------------ ------------ ,!__8p...... Ila_ A-11'fiF-7 — Phone_ f e --------- s Address ------------------------- / Contractor's Name----------------------------- �17i Ei��lCI.fTi7G' Phone--,5;' Installation will serve: Residence )4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Rn Number of bedrooms m Number of baths m Lot size -------------------------------------------------------------- Wafer Supply- Public system K Community system ❑ Private * k h -e.. �Gresss,�Q Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,K Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitte!�jf publicl2ger is available within 200 feet.) of JET ,e Septic Tank: Distance from nearest well -_-__--- Distance from foundation___1 �-__--N-a``te�, [�_ , --------- No. of compartments ____________._ _______Capacity_QQ_____Size!�XLiquid depth_4�z_______________ Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ____-------_---_-______________-____. ❑ Size: Diameter -------------------------------------- Depth --------------------------------------------------- Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------------------------------------ 0 Distance to nearest lot line------------------------------------------------ Seepage _______________________________ _____Seepage Pit: Distance to nearest welt ---------------------- Distance from foundation ------------------- Distance to nearest lot line ____-_-_--------- ❑ Number of pits-------------- Lining material ----------------------- Size: Diameter ----------------------- . Dept h--------------------------------- Disposal Field: Distance from nearest welli-_-----_Distance from foundation --7-10--- to nearest lot line ----- of lines________-__�__ Length of each line______-- A _ �/�` ii 9 ' `♦--------- Type Width of trench__ -------------------- Type of filter material_l�________ _ _____ Depth of filter material -./_r___._____ . Remodeling and/or repairing (describe):___ -------------------------------------------------------------------------- - -i ----1 s �� ----------------- -----------------------------------------------------------------------------------------------------------------------------------------------:---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that 1 h epared this application -and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and ules an regulations o e_s&�oa quin Local Health District. < % �— (Signed)---- ,p!_oF� �` ��S j --------------------------------------- Contractor) ----- ----- ---- --- --- ------ ------------------------------------------------------------- {Title)l�1!A/_ P ------------------- (Plot plan shows ocation of syst in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______ REVIEWED BY ------------------------------------ BUILDING PERMIT ISSUED ---------------------------------------------------- -- A rations a9ndZLreomenda+,ons:_______________________________ ---------- ----�hQJ---- ------ ---- 4,.,V --- ---- - ----------- ------------ --------------------- --- ---------- _ _ ___ _ ------ ----------------------------------------------------- _______________ � --------------------------------------------- ----- 1`a ��---- ---------------- s/ PERMIT No.___� � � ES -9-2M 9-50 W-1639 ___________------------------------------------------------------ _______________ � _1 --------- Date FINAL INSPECTION BY: ------ -_ ___ s Date ------------------------- 1 $ f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California