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APPLICATION FOR SANITATION •PERMIT O (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Dis rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. � ,�J - ------ -------------------- JOB ADDRESS AND LOCATION----------- � -- ---- =— ----------------- --------------------------------------- C ----- - Owner's Name------------------------------------- ./4,r_c�"Z. /------- Phone- Address hone_ _ - ----------------- ` r Address------------ --------------•---��- --- -- ---- -- - �,__ ------•---------- ------------- - - --------.---------- -------- ---------------------- ------------- Contractor's Name---------------------------- �_17: f 'I�° J�'t ftt1;{; rls�'-------------------------- Phone_ F Installation will serve: Residence)IC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z Number of bedrooms jkt' Number of baths It Lot size--- 0_ --I- - --------------- Water Supply: Public system X Community system ❑ Private ❑ Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Im ❑ Clay ❑ Adobe ❑ Hardpan ❑ W f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ � 1 __Distance fr fou ation_� __----pMajer�I__ E_ .-_�_ ______ _________. No. of compartments_______,�r_--_-_______Capacity__�19Q -SizedZ__Ac�_X4X--_Liquid depth__,57.2_______-_- I Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material___________-_________________-______- i ❑ Size: Diameter--------------------------------------Depth-_-------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________________----_ ❑ Distance to nearest lot line------------------------------------------------ Seepage ____________________________________--- --___Seepage Pit: Distance,to nearest well__Avd_+>E------Distance)fr m oundatiorys, --_______Distance to nearest; t line____ Number of pits_____-(_____________Lining material_ ___ ______Size: Diameter__ - -----------Depth_ +______-------_=---- le Disposal Field: Distance from nearest well &_F &___.Distance from foundation_i—k— _________Distance to nearest 1 t line__/___ r-___ Number of lines_____________ __told________Length of each line---_�Q` „__- Width of trench___-r� `__________________ Type of filter materia!__f_ ________S-------Depth of filter ---------- -Remodelingmaterial________� ) and/or repairing describe :__ _--,--- --------� k'- ` ~ p g ) - 5----- -• -----/ - ------------------------------------------------------------------------------------------------------ ------------------------------------------------------- --------- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------- hereby certify +hat I have pDd ed this applicati and that the work will be done in accordance with San Joaquin County ordinances, State s, a rulesegulations of an Jo quin Lqcal Health District. (Signed)_______ --' "' �tlll't�1 'r ----------- 'r Contractor) BY dtJ___�Ci---------------------------------- --------------------------(Title) ! _414014P— p ns, s -rn ize of lot, location of sys+e in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- =------------ DATE------------------------------------------------------------ REVIEWED BY-------------------------- = DATE-/ "~ ---------------- - -- -- - --- DATE - - ----/ - a - --------------------- BUILDING ------------------- BUILDING PERMIT ISSUED----.---------- --- - ---------------------- ------- Alterations and/or recommendations------------------------------------------------ --------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------- - - -------------------------------------------------------------------------------------------------------------------------------------------------------- -----:--- ------------------------------------------------------------------ PERMIT No._L_-Sl ISSUED /----(Date) FINAL INSPECTION BY:------ -(�----------- --------------------------------- �� Date-------------------------- ----- ----- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M MG W=1639