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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 ddCounty Ordinance /No. 549. JOB ADDRESS AND LOCATION---------------4_S#-_eLO._ 28, -------------------,--------------- Owner's Name------------------------------------------------- ------------------------------------------------------------ Phone__j-qr/!� ------- Address-----------------------------------------------------------8; Y m.--c5hWli- 14 Contractor's Name------------------------------------- i9, SHG--;------------------ Phone---?:n-R-40-f Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .Z Number of bedrooms Z Number of baths Lot size__ 'e1rD_ K_X------------------------_-______ Water Supply: Public system* Community system ❑ Privafe X Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)§ Hardpan ❑� 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_ 7-----�-Distance fr m fo ndation__r� ______.Material__ _U� ----'_� �t.��______. No. of compartments_________________-.___Capacity QG_ _______Size, 6� .� " -6 uid de -OW"-_____.____. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_______------------------------------ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------_____________________- ❑ Distance to nearest lot line------------------------------------------------ 01 11 Seepage Pit: Distance to nearest well--- _ ----________Distance from foundation____ ________ istance to nearest/l�ot line_J�7________ 1K (Number of pits-------11-----------Lining material_C%4 __-Size: Diameter__�J��________Depth__.__0_`___________________ Disposal Field: Distance from nearest well-�O'�_____.Distance from foundation__/ -,_--_Distance to nearest lot line___j-"____ Number of lines ----------- Length of each line-----,00='.A-_-4''.Width oF`ench- _ ft'`!----------------- Type of filter materia}__� __ ______Depth of filter material_____- Remodeling and/or repairing (describe):____-__-_/_��__/___________________________________ e-W------------ =nom _,�11__R Q ------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I hapsnd epared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws nd r re lations a San Joaquin Local Health District. Za (Signed) r #"- I.� Asyem .afT____`�i►G• ----------------- ------ ----- E Contractor) �Y� -- ---------- (Ti+le)- Slim--1�--�-�----------------------- Plot plans, showi size of lot, location in relation to wells, buildin s efc. must be fled with this application). ( P 9 . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--(:?------------------------------------------------------------------------- --------------- DATE-- <M --------------------------------------------- R1 V1EW1 D BY _ DATE---- Pl__•'------------------------------------------- BUILDING PERMIT ISSUED--------------- -------- --- -)-------------------------------------- -------------------------------------- DATE----------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------'�------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------- -------------------------- --------------------------------------------------------------------------------------------------------------------- PERMIT No/0-1_1 __ ISSUED___ ____(Date FINAL INSPECTION BY:_-_,�!1W - Date------------ /� } SAN JOAQUIN LOCAL HEALTH DISTRICT !! 130 South American Street Stockton, California ES-9-2M 9-50 W-1639