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e. .APPL,ICATION FO. R.SANITATION? PERMIT / I "' [Complete M Duplicate] „sem .i.. ,Application is hereby made to the.San Joaquin Local rHealth'District for a permit to construct and install the work herein described. t.This application is made in compliance with Counfy'Ordinance No. 549. JOB �� x P a13.f . ---------------------- .ADDRESS AND LOCATION----��$---�--.',6ah -s�'-'- ---5�kn-_ --------------------------- 4-0990• --------------------------------- r Owner? Name-----------Jb-=__Thampao-n- ----- ------------------------------------------ Address -- - - Phone_ - Address__ -:--45-8---w-.6th------------ ------ -------- ----- -- .- ------ --- ------ ----- -- ,? Be 1ta s -- ------ Phone----------------------------------- Name-' -- Contractor s _________ ____ ___ .Installation will serve:. Residence ❑ Apartment House'❑ `Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r 50 x 100 . .. Number of living units:: ] Number of'bedrooms� Number of baths ❑3 Lot size________ _______ _________ ______ _________ s`._. Water Supply:, Public s stem Community system ❑ P,rivete ❑ PP y:` y . Ej El Character of soil to a depth.of 3 feet: Sand.❑ Gravel d .'.5andy Lbam El Clay Loam ❑ _Clay ❑ Adobe( J' l iardpan IZ I TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic feA or cesspool permitted if public sewer.is available within 200 feet.) s Septic Tank: Distance-from nearest well__-_.__ Distance from foundation __-,- _____ Material----------------------------------------------- `' x iqah -------------------------- Exist❑1ag r No. of compartments__---- -_----Capacity---------------- 0 . - --- _-- -Size------- ;----- - ------- ----Liquid depth ` Cesspool: .,,r - Distance from nearest well _______ ; ____-Distance from-foundation____ ____ _._.Lining ma teria4________�----------------------- i i w ----- ---❑ Size: Diameter---- -------- ------------ Depf - j t privy; Distance from nearest well_ _,_____ __ ___ _________,___Distance from nearest building -- --- ❑ ' ..Distance to nearest aot line--------------------------------------------- of -------------- ---- ------ ' -- - Seepage Pit: -. Distance to nearest well.________ Distance from foundation--------- Distance to nearest lot,lane ® s Number of pits-__ -1.------------Lining material__�ti^=�G�-----Size: Diameter------ -- �.$�.->---------------- .nearest - - --- _ _ -y Disposal Field: �'C•"Ance yfrom`.nebrest well,__,____..,_ Distance from foundation--------------------Distance to:nearest lot line 4_- .__ a ® •; .:�, Number'of lines---------------] ,_.__._____Len to of each line____ ----------Width of trench ___��: I0------- - Type of filter,material____ a _- Depth of filter material_____-18t�-------- , -Remodeling and or re airir describe: __-_:_____--re-,pa-lr - -------------- ------------------------------i --------------------- -- ,; = - -------------=------------=---•---------------------------------- ' e prepared this. application and that the w. ,'hereby certify.that 1.hav - = - - -- --- --- ordinances, State laws, and rules work will be done in accordance with San Joaquin County, es and' regulations of the San Joaquin Local Health District. } e r � {3i;ne(Owner and f o. r Contractor) (Signed) - -- D _ tR_------ - - ------- ----- ----- --' -(Title)sy= ' - W_atthan------- ------ ---- ------------------------ (Plot ---- --- - (Plot a plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). ` FOR DEPARTMENT USE ONLY ACCEPTED BY -' _ DATE- - --- ---- APPLICATION �`5 f . . REVIEWED BY -- . ----.- . ---------- ---- DATE-Y-7 --------------------------------- .. -"------------=------------ Alterations and/or recommendations--- ---------------- ------------------------------------------------------------------------------------------ QATE--------------- ----'-- =- ------------------------------ - ` BUILDING PERMIT ISSUED------- ---------=------------------------------- ----' ----' --- - --. ,--- ----- PERMIT No.-- 1 --- ISSUED- ----------------- 'FINAL INSPECTION BY:-- - -'- '----- --- --.s7 _ - '- , Date--- ��}- --------------------------------- R SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street x Stockton, California ES-9-2M 9-50 W-1639 'e