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� ( y 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. JOB ADDRESS AND LOCATION----------1-4-45---Temi.le---- - ------------------------------------------------------- ------------------------------------------ Owner's Name------ '-�+yz.°,axL-----Sallie--------------------------------------------------------------------------------------------------------- Phone------3-2652----- Address----------------•14-1+5--- P-mgle------------------------ ---------•-------------------------------------------------------- -------------------------------------------------------------------- Contractor's Name Ue is 13 ,- .0 `'aXlk--�9Tv iC--------------------- ----------- ----------- Phane - Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Co Number of bedrooms 2,] Number of baths [2 Lot size-------}Q-1QD-----------------------------_________ Water Supply: Public system Ea Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 13• 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--------------------Material________________-_-_________________________. _. laxfstIng No. of compartments--------------------------Caaci ----------Size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El ___________________-_----- ______❑ Size: Diameter--------------------------------------Depth-------r------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest build-sng-_________._---__________________________. ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______5t________ Number of pits__________________Lining material____ Size: Diameter._________________.Depth----- __BvIr__ _0 Disposal Field: Distance from nearest well________________Distance from foundation--------$!l-------Distance to nearest lot line----------------- [ Number of lines-----------1---------------------Length of each line---aPP--___'�Q1____.Width of trench---alP2-_2-2_ ------------ Type of filter material---rpzk----------Depth of filter material_____1$.11 __-________ Remodeling and/or repairing (describe) T_epa-I _Ing------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------•-•-------------------------------- -------------------------------• -----------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)------Delta--aS-eP-t-J.0---`' C3 '------- ------------- ---- ----------------------- ---------------------------------(Owner and/or Contractor) • Owner-Mgr- -49--a . By:--------Perr�r--ffda han r IT�tle)--------------------------------------r (Plot plans, showing size of lot, location of sys m relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- - -- -------- ---------------------------------------------------- DATE--------i ........... BY---------------------------------------------- --- ---------------------------------------------------------------- DATE---------- ----------J------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------•----------------------------------------------- ----------------------------------------------•--------------•----------------•--------------_----------------------------------------------------------------------..------•------------------------•----------------------- -1-1-1-- --------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -----••-•--•----------•--------------------------------------------------------------------------------------------------------••-•-----------------------------------------•----•---------•-------- --------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------•-------------------------- PERMIT No.__-!?-7-5•------- ISSUED-------- V'---S--------------(Date) FINAL INSPECTION BY: _t_� _______________- . Date------�- �/------------------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639