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APPLICATION FOR SANITATION PERMIT * (Complete in Duplicate) Applicafion 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 comm;-9 with County Ordinance No. 549. JOB ADDRESS AND LOCATION �ALA _ _L. C�. -j--------P- -- ........................ ---------- ---------- _ L Owners Name-------- �' #- F1--------------A--- --- --------�LJ. ----------- Phone C� ``�j ) ------ Address ---------------------------------------------------- Address----------------------------`- n0�� ........ --l-------- ----------------------------------------- --- -------- Contractor's Name 7 ` PA--RJq'1--5-ff--4-=o�F`�-.V_�`__-f---�/-�'e -------------------- Phone��7-(0 Installation will serve: Residence ❑ Apartment House ❑ Commercial V Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size-_/e)--- _ L� -___________________________ Water Supply: Public system W Community system ❑ Private ❑ Q Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy, Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4- Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: p - (No septic tan or cesspool permitted if public sewer is available within 200 feet.) f Se tic Tank: Distance from nearest well__________Distance from foundation_ ____--__ ___._Material_�OIV1---�,�p�'�_______________ No. of compartments_- 9_L__ -___.Capacity_�+_r__-dQ�x�ft__Siz�'4-��__��!'____Liquid depth___10'�__________ Cesspool: Distance fror"Tnearesf-well-----------------Distance" from foundation-- -- material------------------------------------ ❑ Size: Diameter------------------------- ------------Depth------------------------------ f--------------- ,Privy- Distance-from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to'nearest lot line_______________________________________________ Seepage Pit: Distance to nearest well_________ ________Distance from foundation___.1 _1_____-Distance to nearest lot line-_f /� �i ( Number of�pits__,Ct -------Lining mate -Size: Diameter__ �1-------------Depth__��1�------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line________________ ❑ Number of lines-----------------------------------Length of each line----------------------_-------Width of french----------------------------------- Type of filter material________________________Depth of filter material_____-------_____-_____ i A f ARemodeling and/or repairing (describe): - rl[9h/--�--------------------------------------------------------------•----------------------------- - f� -----------------------=-----------------------------------•------•---• --------------------------------------------------------------- -------------------------------------------•--------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ---------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1' �Q (Signed) / e I-------------- 4 � _ �.�1 - -r�!✓�� (Owner /or Contractor) aC_ -'�-aif {Title) IV,-&- By:---------- ----------- - (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application), FOR DEPARTMENT USE ONLY -------------- APPLICATION ACCEPTED BY------------------- - ------------------------ ---------------------------------------- DATE--------- '��`" REVIEWEDBY------------------------------------- -------- -------------------------------------------------------- DATE----------------- - -�.+.� -S-?---------------- BUILDING PERMIT ISSUED-------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------- ------------------------- a ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ------------ ---------------- - ------ ---- ------------------------------------------------------------------------------------------------------------------------------- _ _ ISSUED_-- _- � (/ --PERMIT No.___ ._____________________{Date) FINAL INSPECTION BY______________ Date--------------------- - 1r_ _ !__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 A