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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 Ordinance No. 549. k JOB ADDRESS AND LOCATION______ _Lam --------------------------- Owner's Name ----------------0 -0-co-nom_'s----- ce Address ---------- - ---------------- ---------- ----- Pone--- -- -- ----- - ---------- --------------------------------------- �� _ - - f == Contractor's Name---------------- ----- --- ------- -- _11 /S --- ! Cly------------------- Phone- Installation will serve: Residence X Apartment House E] Commercial. El Trailer Court ElMotel ❑ Other ❑ Number of living units: Number of bedrooms,] Number of baths 2' Lot size-A-10--e-_,rb_-_ i Water Supply: Public system �( Community system ❑ Private ❑ I Character of soil to a depth of.3 feet: Sand E] Gravel Loam ❑ Clay Gravel Sandy.. Y Loam ❑ Clay ❑ AdobejK 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-40A6____Distance from foundation__ _ � 1�----------.Material_G-f% ------------------ No. of compartments-------------- ------Capacity.&O--------------Size _id_XA_rS_ !�Liquid depth------- Cesspool: Distance from nearest well_______________ Distance from foundation___________________Lining material--------------------------------------- 11 _-- Size: Diameter___________"____--_--_"-_ i ------------Depth---------------------------------------------------- Privy: Distance from nearest well_--__-___-_________________ ___ �� _____________Distance from nearest building i ❑ Distance to nearest lot line g = ----------------------- Seepage Pit: Distance to nearest well---/ QAW-------Distance from foundation_ D�-_____.Distance to nearest lot line_.. ___-__ 94 Number of pits------/-------------Lining mafierial__ G_ A $ize: Diameter__xS3_�i_ — .. Depth-_A4__-_r_.!�•------------- -Disposal Field: Distance from nearest well__#1CWF_-__Distance from foundation�,.��-__--- "-__.Distance to nearest lot line__s'_--____ Number of lines---------------L________------Length of each line___.,ZA2__`__-----------.Width of french-_AK'F' _----- Type of filter material___/_y1W4_-___-Depth of filter material-_____-_/�r*_---_ Y-Ad Remodeling and/or repairing (describe):______ ----------- ---------------- -------------------------------------------- hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rues nd regulations of the San Joaquin Local Health District. (Signed).---- r -------�. .eird ,f__ _ v----" --------- - dh Contractor] i :. K�---'�'- ---- -------------------------------------------------- -� -- -- --------- -------(Title) ______________ (Plot plans, sho n ize o lot, location of s tem in relation to wells, buildings, etc., must be filed with this application). on). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______ _ _ REVIEWED BY ------------------ - - --- --- DATE_ ----------------------------------------------- - ---------- - DATE------'x7 '-------------- BUILDING PERMIT ISSUED____________________ - ------- - " " DATE---------- ----------------------------------------- Alterations and/or recommendations_______________"-_ --- ------------------------------------------------------------------- ----------------------- ----------•------ ---•-----------------------------------• k ------------------------------------------------ _______ ______________________ i __________________________________ _ __ _ _ ___________ PERMIT No-------- h ISSUED---- . - - AiL INSPECTION B �i. - ---(Date) FINDate"--------- � -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street } s ES-9-2M 9-50 W-1639 1 Stockton, California