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� 3 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------- eHt 7 #o__..I 1'!!_�" 3 X12©_CSL i�}11- Phone_3'.'2Qk ------------ Owner's Name--------------------------- 0. E1.mer_:Kitterman--- -------------------------------- Owner's Name '1�� tr�l4ti ��Q��ton-----------------;-------------------;- A ,P a Phone_ Contractor's Name_ ----------------------------D�----- �----- �„Y'x''�.8�1- t� --�9n�---�Y1C_�t_!------1----- --�--- - , Commercial ❑ Trailer Court ❑ Motel ❑ Other Installation will serve: ResidenceXI Apartment House ❑ 6 50 1 100-1 --------- -- Number of living units: M. Number of bedrooms a Number of baths Lot size______-_______- ___- � Private.[-] Water Supply: Public system [N , Community system ❑ Clay Adobe. Hardpan ❑ 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑� Sandy Loam ❑ Clay Loam ❑ Y ❑ _ x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �i0ile—Circ—$ri-ek t Sb";�36"x630--Liquid depth---S2„ Septic Tank: Distance from nearest weILHQI7e__--Distance from foundation______ -----------Materia______-__------------------------------------------ N(;. -___-__-_--___ _ No`, of compartments______-2_______-____-_Capauty_..9�� -----Size .. - ---------- -- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Size: materia------------------------------------ Cesspool: f_:__--------_----- - `! ❑ Sizer Diameter--------------------------------------Deptb--------------------------------------------------- 171 ------------------------- -- V ________ __ ___________Distance from nearest building --------------------------------- -------- Privy: Distance from nearest well________________________ - - ❑ Distance to nearest lot line------------------------------------------------ 1 Seepage Pit: Distance to nearest well--N-OAP__-___--Distance from foundation-___2.2 _______Dis13--- t-- nearest lot lin _____14 _--- Number of pits________-----------Lining material_j0,?&_!_3Me: Diamete- p ' Disposal_Fielc1::. —Distance from.-nearest-well---�-oS10__.DistanceLfrom founclation_.__ Q_ --------Distance_to_neares# lot line-__5_1 -----Length of each line--------3Q-----------------Width of trench------ Type ----- Number of lines_______1_______-_ p Type of filter m-.-. L____l M-----------Depth of filter material___18------------- Remodeling and/or repairing (describe):--------- ----------------------- - --------------------- ------------------------------------------------------------------- -------------------------------------------- --------- e work I hereby certify that ndhrulespan,�' regulations olf the San Joaquin Local HealltheDistrlctn accordance with San Joaquin County ordinances, State laws, A'. PARRISH._k-5090,----INc±►_--------- t----------+---------0---------a--------- +----------( Contractor] (Signed) EBt .ID1tOr�_�- ------------------------ BY� - (Title - (Plot plans, sho in g size of lot, loca+ion of�,�ys+em in relation to wells, buildings, etc., must be-filed with this application . FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY_ ---------------------------------- -- ------------------ -------- DATE REVIEWED BY------ -------------------------------------- ----- -- - � -- -- ------------------ -------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- ------- ---- DATE----------- ---- --------------------------------------------------- V and/or recommendations:__________--------- ----- -_.-_---_--_________--___---.____.____ ---------------------- ----------------------------- ---------- --------------------------- ---------------------- --- - ----------------- ------------------ - ------------------------------------------------ * ,'�_______ ISSUED:_____ (Date] FINAL INSPECTION BY:-_----__ ____ - .-- -_ - PERMIT No.__. -- �/ -�. ------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639