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APPLICATION FOR SANITATION"PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin local Health Disfirict for a permit to construct and install the work herein describe This application is made in compliance with Coun+y Ord_ inance. No. 549. i s herein `J1'e�20 E- / `�' JOB ADDRESS AND LOCATIONf_i-_'_ q Owner's Name"__._""__"" --��Il--------------- o`sem'r��---- - �--�,f� d,"_- .1` - --r---- ---- ---------- -r------- Phone----- Address Add - ,. - ---- --- - '--- ln.0#-------:�i ------- �1Sfa�-% Contractor's Name._."""_ { .< ----____"_____ r----- �`=- - --------- Phone----- i .. Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel Number of living units: •Z) Number of bedrooms ❑ Other [] u:, Number of baths [� Lot size---i ,3'------X__ Q-`-----------------1_ 4Water Supply: Public system E] Community systern�E] Private f Character of soil to a depth of 3 feet: Sand E]-Gravel E] Sancl.y L aam ❑ 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}nea`rest well--X,--,---- fl 14 " Distance,.-from foundation______/__4_ �______Material`- " �1Q. No, of compartments"_""__L" " ,� _ "------------- f __- ___, ---- "Capacity"_ %Qa_-�Size Cesspool: I , cr_- , �tt►`t"R"`a------------------Liquid depth ' L 'i 9 ma' P Distance from nearest well "_.____ :_D�istan�e from foundafiion""____" ___ "__.Linin' material__""______________-__"_ Size: Diameter______ --------------------------------_- - ___Depti,_; -------------- = Privy: 71 Distance from nearest well ____„_ Distance from nearest,build in ❑ Distance to-nearest lot line �- 9 --- --- ---_"" ---__-" ----___ t Number of its___"_____ I Sepage e Pit: Distance top BarestII_1- __"___Distance from foundation__----� ____-.Distance to nearest lot line--_ _ "• 9 j s�linrtig•-mater�'a - +�-ad:u� _t__ -Size: Diameter 3-� .Depth------� 3 p sal Field: Distance from nearest well"__ B:r-Distance from foundation_---_-/__`""__Distance to nearest lot line-"---Iq-____ Number of lines-------------`----I "-""" Length of each line----- o Dispose _Type of filter material__0- " ---- l---"� -- Width of french------2-- --"--------- --- Depth of filter material___-__I'_:L" """"---- Remodeling and/or repairing (describe):--- f„r, � e� � c.moi ---------- _”-------------------.____-__------------------- '----------------- "___" "___"--____"_""____-""._""-"_"_______" M _--___-_---______--_______--_______---_---___ __-__----____-_.-______------------___--________-_----_____ ___-_ Joaquin oun I hereby certify that I have prepared this application and that the work will be done i---------------------------------- """_ 1.----------- accordance with San Joa C ordinances, State laws„and rules,and ti regulaons of'the San Joaquin Local-'Health District, q (Signed f -------- - ( ef Contrac r Br• - 1 (Plot plans, showing size of lot, location of sy em in relation to wells, buildings. etc., must be Ele�h this a li ------------------------- 9 ' pp cation). �A FOR DEPARTMENT USE ONLY \� APPLICATION ACCEPTED BY___________-"" REVIEWEDBY---------------------------� --- � ------------ ----------=_------_------- --------- DATE-------- ' --- ----- = -- -l--ILDING PERMIT ISSUED------------------------ � f-----------y---------�--- ------:- ------ ---------- ----- - - Z----- -------------- Alterations and/or recommendations------------------""""- DATE----------------"_"-- --------------------- ------------------------------------------------------------------------------------- -----------------------I--- -- 1 a ----------------------------------•----------------------------------- --•- ------------------------------------------ ------------------------------------------------------------ -" ----------------- --------------- ` ---------- PERMIT No.---]---' /----------- ISSUED------ � __(Date) FINAL INSPECTION,BY:---__ J1 / i i Date `] SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street '9-2M 9-50 W=1639 Stockton, California { # , �