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�33 l 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 Ordina nce No: 549, JOB ADDRESS AND LOCATION---/0_#Z__- -- �----------------------- ----------------------------------------------- Owner's Name------------� ----;�E1_.�rY1 --------- Phone------------------------------------ Address--------------- -------_----••-------- Contractor's Name----------13-- ----------------------------------- Phone----52_-7_Y©�---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 5, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths Lot size________ _ Water Supply: Public system Ig Community system ❑ Private ❑ * Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [X Hardpan ❑ % TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e Septic Tank: Distance from nearest well---- "----------Distance from foundation....../_A_-_-- f�_.Material------- dmAo_ -------------- 56 No. of compartments--------.-'),_.---------Capacity----/_-X0-0-------Size---1,641-_!L-_S__~,------Liquid depth------Vit-----------------. Cesspool: Distance from nearest well____-------------Distance from foundation---------_________.Linin g material_________________________-____-_---_ ❑ Size: Diameter--------------------------------------Depth------------------ -- t , Privy: Distance-from nearest well------------------------------------------------- from nearest building______________-____-_____________-____. ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation__________-.__:____.Distance to nearest lot line_________________ ❑ Number'of pits----------------------Lining material-----------------------Size. Diameter------------------------Depth________.___. -----•------------ Disposal Field: Distance from nearest well-__________Distance from foundation_-___x_92 ____.Distance to nearest lot line_-___��_____ Number of lines______________I-------------------Length of each line------------_-_40-_--------Width of trench---------�_�}________-_._____- Type of filter materialA4"_t'Qk�__Depth of Cter material-------bf.._______ Remodeling and/or repairing (describe)=----------iY'-QVJ-----• - ' �. [p -------------------------------------------------------------------------------- -----------------------------------------•---------•---•---------------------------------------•----------------------------------------------------------------------------------------••----------------------------------- ------------------------------------------------------------------------------------------•------------------------------•------------------------------------------------------------------------------------------------ - I hereby certify that 1.have prepared this appli>ation and that the work will be done in ccordance with San Joaquin County ordinances, State laws,`and rules and regulations f the San quip Local HeaDistric (Signed)_____n� R.-_ _ .4_ ......u-7-- ----------- -- -- ------- ---- - (Owner and/or Contractor) BY: . ----------------------------------------------------------(Title)---------------------------------------------------------------- (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 APPLICATION ACCEPTED BY---------- ------------------------------------------------------------- DATE--------- - ----1�' REVIEWEDBY-------------------------------------------------------------=--------------------------------------------------------------- DATE----------------------------- BUILDING PERMIT ISSUED---------------- --------------------------- DATE Alterations and/or recommendations--=-----------------------------------------------------------------------------------•----------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------•--- ---------------------------------------------------------------=---------- ----------••--------=----------------------------•-------------------------••------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------- PERMIT No..'3 'A' ---------- ISSUED--- '` -b-s -----------(Date) FINAL INSPECTION -BY:----------�1� --------------------•----------------- Date----------------I----- --�r-6---�-b SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W4639