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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ? `� Joaquin Local Health Disirict for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION---_---._--- --- -- 1626_-PalM__AYenuP-- Stock on----------------------------------------------------------- I --------- --------------- Phone 3"---- =-----------------Peke- Olsen Owner's Name--------------------- ---------- ----- Address-------------------------------------------- ----- ------------------1-626--Palm--A-ve e-------------------------------------------- ------------------I Phone------�---�6Q7--------------- Installation & SONS_ TNC-*---------------------------*-------------- - ❑ Contractor's Name------------------- �----- _. Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: [I Number of bedrooms E3` Number of baths [}L Lot size----- ---------------------------------- Water Supply: Public,.system%X. Community system ❑ Private ❑ �. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay El Adobe Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----.M a to r ial------------------------------------------------- Septic Tank: Distance from nearest well__ --Distance from foundation --__ -- Liquid depth------ No. of compartments--------------------------Capacity Size Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- IDDiameter-----=--------------------------------Depth 'Privy: Distance from nea Distance from nearest building------------------------------------------- rest well---------------------- ❑ Distance to nearest lot line---------------------------'------------------ ,l t ..- -_...Distance to nearest lot line_- -__----- Seepage Pit: Distance to nearest well on-e-_----Distance from foundation___-_ �r 33-------.Dept h----------- Q---------------- Number of pits----_--1--___-____-Lining mater4al___CQ��CzE: Diameter---------- . ..Disposal Field: Distance from nearest wellDistance from foundation- -Distance to nearest lot line_________________ _--_----___- -- ❑ Number of lines-----------------------------------Length of each kne-----------------------------Width of trenc Type Type of filter material-------------------------Depth of filter material----------- -------------- [ $'tem -Remodeling and/or repairing (describel----------------�1�-��.EIIl��'�---�-0---e -��j.��---dI'&1na9E_--Sy--------------------------------------- ------------------------------------ ----------------- ------- ------------- -------(----- -------------------------------------------------------------------------------------------------- ------------------ ------------------------------------- - -= at ---- ---------- - - ------------ ------- --- ------ -------------- ordinances,herb cer ify that andhave ulesprtepand'a eed gulats ap lli the San Joaquin hLocai Heall heDis}re{n accordance with San Joaquin County State INC ...... O3 ontractor) (Signed) A-- - r ---------- '- ------------ ----- Y (Title) E S t i o - - --------- - - - ------------- ----------------------- [Plot p ns, s wing size of lot, location of syst in relation to wells, buildings, etc., must be filed with this application . FOR DEPARTMENT USE ONLY + DATE------- ------- ----- APPLICATION ACCEPTED BY---- ------------- DATE ----------- I a � `til f .--- - ---- --------- - DATE---------- --------- -�:---- ----------------•------------ REVIEWED BY----------------------------------- ------------------------------- --------------------------------------------- --------- DATE - - -------------------- - ---------------------------------------------------- - BUILDING PERMIT ISSUED--------------------------------- - -------------------------------------------------------------------- ------------------------------------ Alterations and/or recommendations:-------------------------- - --------------------------------- ----------------------------------------------------------- ------------------------- ----------------------------------------------- -------------------- , ---------------- ------------- -----_----------------_-------------•--------------------- v 1 ---------_--------_- �� _ 3 --, ------- Date FINAL INSPECTION :-------------- ----- ---- ----- ------------------------------ PERMIT No------ --------- --- ISSUED- ------ ------------ - - (Date) �_� �� .f -'---- -- ---------------------------- F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American"Street Stockton, California ES-9-2M 9-50 W-1639 .y