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•fes , "7 41- 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, JOB ADDRESS AND LOCATION_-.,-,-------1-------- !'o____--± ROr✓ �, STfeh'TslN Owner's Name-----_U oZYN------- -1 -------1,,rn�_ ,l�_+ lI-------------------- ---------------- ------------------------------------------ Phone--- Address------- � /6 Cl� t! /�'-!C_�!w E E " Contractor's Name----------------------------- - --------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence Ee Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -❑ Number of bedrooms m Number of baths [E Lot size___---__---_ __ Water Supply: Public system ❑ Community system ❑ Private fp' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[?--"Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well_ ---------Distance from foundation------ ----------Material __________________________-_____________-______ No. of compartments---2-t -------------Capacity-----------------------Size------.-------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- nSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well_______________________________ _______________Distance from nearest building----------------------------------------- 171 Distance to nearest lot line______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_-____________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h-------------------------_------- Disposal�Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest loft line_________________ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material ________________-__ - Remodeli g and/or repairing oe ribe]:- - --- --- p--V�//,.----- �; - --------- ---------------------------------- -- ----•--------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ; ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ - ---------------------------------------- 1 hereby certify'•t at ).,,have pre ared is applica+ion arRd that the work will be done in accordance with San Joaquin County ordinanceSti64elaw �rul an u atio o the S �i`Joaquin a e th District, (Signed) ----- --- ------------------------- ----- ---------------------------------------(Owner and/or Contractor) $ -------------------------------------------------------------------------------------------------------(Title} --------------------------- (Piot pla lo+, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY ------------ APPLICATION ACCEPTED BY--------------------- -- __ 44 SZ - -- ------------------ DATE ------------------------------ REVIEWED BY--- ------------------------ DATE - BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- Alterations and/or recommendations----- ----------------------------------------------------------------------------------- --------- ' e -------------------------------------- -------------------------$6--- -------------------------------- ` _`— ------------------------------ -------------------- -- ------ ------ - --- ------- ---------------------- -- ---- - -- - PERMIT No.--..#7.-(o---------- ISSUED___- ____(Date) FINAL INSPECTION BY:.-------- ___ -------------------------------- Date---------------------------1 € /L ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ( ` 130 South American Street Stockton, California ES-9-2M 9-50 W-1639