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APPLICATION, FOR SANITATION PERMIT e� (Complete in Duplicate) Z �i y Application is ereby 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. r JOB ADDRESS AND LOCATION-------102-8---$ ;5-i n01air-------------------------------------------------------------------------------------------------------------- k Owners Nam S' -! �" r _ W11he3?t R �B�sri€�------------- ------------------------------------ Phone-2__9.&5-',- ----------------- f Address..-- xL_ .x'--------------------------------------------------------------------------- ---------------------------------------------------------------------------- Contractor's Name------------ 1 .- �` :--------------------------------------- --------------------------------------------------------------- Phone--'}---3-9-55----------=----- _ -Installation will serve: Residence ❑ Apar�ment House El Commercial E] Trailer Court E] 'Motel El Other ®�eeabins i Number of living units: 2 Number of bedrooms G Number of baths ® Lot size__3,0.0'_x,150-___-__________._________._________ 4 Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ek Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distancelfrom nearest well_________________Distance from foundation--------------------Material----------------------------------------_____---- exilsfIng _ No. of compartments--------------------------Capacity-----------------------Size------------------------------__Liquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining 'material________________________--__ __. " ❑ Size: Diameter---------- ----------Depth---------------------------------------------------- �i i Privy: Distance f`om nearest well_________________________________---------_---_Distance from nearest building-------------------------------------------- Distance _-__------------ --- Distance to nearest lot line------------------------------------------------ Seepage ------------------------------------•---____--Seepage Pit: Distance to nearest well-----1�0_-___Distance from foundation________ ________Distance to nearest lot line----�G7____- i 1 ' ® Number of pits---------Z Lining matertal__br_iSX------Size: Diameter__._#__________________Depth_____ _ ..Disposal Field: Distance from nearest well------------------Distance from foundation____-____--_--_---Distance to nearest,lot line____;_,___ existNumber 811ines--------------------- --- g � ___Length "of each line___________________________.Width of trench______________________ Type of filter material________________________Depth of filter material----------------------- "Remodeling' _-_.___----___--- ----- r g / repairing! p g "-Remodelih � and/or re airin '' describe __________________________Y'_e_ iY' _____i12�f�-gl + { } per. ing- �— l�.g---nam---�rert�_cal----------------------- -=-----------------------•--------------------r----------------------------------------------------------------- ---------------------------------------------------- + --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ---------------- --------------------------------------- -------------------- - - ------- --------- --------------------- - - --- - ------------- ------ ---- ---------- 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. D_e1ta,_ I ' (Signed)-------------------- s------------------------------------------------------- ------------- - ---------------•--------------------(Owner and/or Contractor)By ;. ,P_err _ �7la.r_thsn-------- --------------------------------------------------------------- Title ---flW_ner.�X -r-•-------------------------------- (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 ay Y-----`-�'j--`----�------------------------------------------ ------------------------------- DATE--T' -�r Q_ 7------------------------------ APPLICATION-ACCEPTED B w J r�— REVIEWEDBY----- --------"-------- ---------- ---------------------------------------------------------- DATE---*a=__t_-_97_ --------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- ---------------------•--------------- DATE---------- ----------------------•---------------------- Alterations and/or recommendations--------------- ---------------------------------------------------------------------------------------- { t ------------ ------------------------------------:------------------------------------------------------------------------------------------------------------- ------------- --------- - € I - -- ------------- ------------------- -------- o -- ---- IS" - `--------(Date) FINAL INSPECTION BY----------------------------------------------------------------- -_.. pp PERMIT No��_ _ SUED____________.Q�•S� I llDale-------------------------------------------------------------------------------- q SAN JOAQUIN LOCAL HEALTH DISTRICT !� 130 South American Street ; Stockton, California { ES-9-2M 9-50 W=1639 it i 9 – -