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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a This application is made in compliance with County Ordinance No. 549. permit to construct and install the work h,� r(�m ascii d. - JOB ADDRESS AND LOCATION_ � _$en$0 n Str e_t; 5t0 t0n 'Owner's Name--------E a-- Ll--B-o- s----Calif&------------------------------------------ _l�oberta--____(__Robert---Allen_Job- -- --- Address - -- Phone Q _ _ �_t�e�t St�o_cktciln- ---- ------------------------- -- Contractor's Name D* r. --------- 9-96p` Instailation will serve: Residence j -- �- ---•- -*-- --l------'"--" "'" ---__0___ -- a----- Phane--------- ___ Apartment House ❑ Commercial Number of living units: �] Number of bedrooms P Number of �MS4D TrailerCourt S z ❑ Motel ❑ Other ❑ Water Supply: 1 PP y: Publics stem r---.____"__lOQ Y �. Community system - ------- ------------------------ Character of soil to a depth of 3 feet: Sand ❑ Y Grav�❑PrlSandy❑LoamCla ❑ y Loam ❑ Clay El Adobe TYPE OF INSTALLATION AND SPECIFICATIONS: [X Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) " I ' Septic Tank: Distance from nearest well---------------- Distance from foundation------------------- Material______________ ❑ No. of compartments-------------------------- CapacitY-----------------------Size-- --------- -------- -- -.......- ---- ----- + Cesspool: __________________Liquid depth__-__--__-___ _ P Distance from nearest well_________________Distance from foundafion--------------------Lining material___.___-_---_--__--_ _ -------- ..Privy: Size: Diameter--------------------------------------Depth------------------ ------------------- ,V1... rrvy. Distance from nearest well________________ _ __ Distance from nearest buildin ❑ Distance to nearest lot line---------------•_-- ------------ - g-- ------------ -- - I eepage Pit: Distance to nearesf well______________________Distance fr°m foundation___________ Distance toineares Number of pits------------ ------Lining material------ __ '�r line -" - --- ----------Size: Diameter---------------- ----.Depth- --._.- - - - - .-Disposal Field: Distance from nearesf well__NOI3@! �t ---------1 Distance from foundation__ ___ Distance to nearest lot line____�0Number of lines___________________ Length of each line__ _- --___- _- Width of trench____.____Type of filter material_______1 pN -- -Depth of filter material--- �2M -" ------- - Remodeling and/or repairing (describe):__-__-____- $ dr; f.n---Q-f x ��3at----------------- ------------------------------------------------------------------------- -------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and re .+ibns of the'San Joaquin Local Health District. -(Signed)----------- --A` 61111K -------------&*---------------------0 i-------- Contractor) By:---- - --I-----•�-�-- -- -- �--- �-� � _ Estimator Y Pot pla g (Title)- s iri sae of lot, ocation of s em in relation to webs, buildings, etc., mus+ be filed with +his application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y __---------------"-___ _ __ " REVIEWED liY- DATE f -- ---------------------------------------- f ------ BUILDING PERMIT ISSUED__ _ - ------ - DATE -- ----------------- - ----------------- ------------------------------------- DATE------------------------------- ----------------------- and/or recommendations_ --- ---------- - -------- ------------------- ----------------------------------- ------------------- --------------------- --1 ------------------------- ----------- ------------- - ------------------------------------ I --------------------- ----------------------------------" ------------------------------------------------------------------------------------ ------------------------------------------------------------ - -- PERMIT No.----- ---------- ISSUED---- ------------(Date) FINAL INSPECTION BY: W-.i�--�--__- - -------------------------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street �S-9-2M 9-50 W-1639 Stockton, California