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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate Application is hereby made to the S-an'Joaquin Local Health District for aIPermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ 3 wner's Name----------A.11-e l_ . ----------------- Phone--3-n-8555--------------- ---------------------------- Address-------- �7--�+`--•- ----------�t..�71.-�t '-�--�'-��r1'-,----{-r-�l�f•-------- _ ---------------------------------------------- ------------------------------------------------------------ Contractor's Name-----------]�Q _5.---.ept_.Q__;I'_SXlk---Service_-------------------------------------------------------------------- Phone----3_"3955------------- Installation will serve: Residence ❑ Apartment House ® Commercial ❑ Trailer Court Number of livingunits: ❑ Motel ❑ Other ❑ � Number of bedrooms.19 Number of baths ®. Lot size-A-00 Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa m❑ 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------------- Distance from foundation______________ ❑ Capacity No. of compartments--------------------------Ca Material p tY-----------------------Size__ --.------------- -----•------Liquid depth---------------- ❑ Size: Diameter Cesspool: Distance from nearest well-----------------Distance from foundation_____________.------Lining material-___.___________________ -----------------------------Depth-------------------------------- Privy: Distance from nearest well-___________________________-_________--_-----Distance from nearest buildin ❑ Distance to nearest lot lineg___ -_ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest 10# line______ ______� ® Number of Pits________,-----------Lining material----Dei @ --_Size: Diameter__-____' e '--_ Depth�o---c---- Disposal Field: Distance from nearest well________________ Distance from found ation____________________Distance to nearest lot line______________.__ ❑ Number of lines--------------------- ------ -----Length of each line-------------_--- Type of filter material-------------------------Depth of filter Width of trench----------------------- material----------------------- --------- Remodeling and/or repairing (describe):-------reP_A rjj_:jS_ -..-_--�ea�h n _system existing___ 30o-felt . ---------------------------------- --------•--------•---- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed)Sr y:-------Perr-3�---Warthan - ' g e ' Se fit- ---�=:Lxlk � _, .EtrV_j-0f3__- (Owner and/or Contractor) max_s• _Title---- -__0_wn_er_ . (Plot plans, showing size of lot, Iota+ion of s stem ' relation to wells buildings, eft., must be filed with this application). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ REVIEWED BY -/-------- - - DATE__.--- ----------------------- -- -----7� jr�------------------ BUILDING PERMIT ISSUED-------------------------------- ------------------ ©ATEDATE - ---- - Alterations and/or recommends+ions_ _ ----•--- -- --------- ------------------------------------------------------------------- -- PERMIT No_ 155UED___� /G - - (Date) FINAL INSPECTION BY-.--49 4 -- ----------------------- Date_____ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California