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a APPLICATION -POR -SANITATION-PERMIT—•r- -'• {Complete in Duplicate) Application is here-13 made to the San Joaquin Local Health District for a permit tc construct_pan file work herein des�bed. This application is made in compliance with County Ordinance No. 549.E } JOB ADDRESS AND LOCATION______ _ .. -el-a a ------- � _li!__l_ ------------------- Phon l Owners Name--------= ----- - --------- - - - - - ---- yam- ,r/ g� Address - "� !_� / fel- 1 --------------------------------------------- ------' l :. � ,. r �' Contractors N me----v �-- � �--I�1 u ---- ----------- �'�J�y4��j°--.l^�1llr Phone_�f'.` Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel El Other /(f Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size_a� � _------y--- -•----�'---- ---- Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand [-] Gravel ❑ Sandy Loam ElClay Loam ❑ Clay ❑ Adobe [ Hardpan E] �V 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------------------------------------------------- ❑ No. of compartments--------------------------CapacityF M Size Liquid depth ,Cesspool: Distance -from nearest well________________ Distance from foundation--------------------Lining material------------------------------------- N ________-_____________ - ' ❑ ---------Depth--------------------------------------------------- Size: Diameter------------------------------ - Distance from+nearest building-------=---------------------------------- Privy: ; Distance from nearest well_________________________ _--�' 1 ❑ Distance to nearest lot line.---------------- -------------------- Seepage` Pit: ; 1 Distance to nearest weli_,;___-_'__t°._"=Dis`ence from foundation______s__'� Distance to nearest lot line____.-__'_.______ p' Size-DiameterDepth------------------------- �I ❑ t 9 Distance from foundation__--__1�__,- Numbef of• its_________-� __I_YLin�inmaterial___._____ -+l=bistance to nearest lot line.__��___ Dispos 1 Field;. FDsstance from nearest well_ ........ r Number of lines_____��-- -----------------Length of each line_ - ��!Width,of trench__ _± t f_�___'---------- r / Type of filter material__ E�._f-____-Depth of filter material___ `� � � - IL J ' Remodeling and/or repairing''(describe):, _y- ___ ------------- - ------ '= w-= ______________________________A--------------------------Y .________-•__________________________________ s _______________________________________ _______________________________________________________ _________________._______-____________,_____________-_____-______________—_______._.____.___-_______________._ hereby certify that I have prepared this application and that the work.will be done in accordance with San Joaquin County ordinances, aws, and rules and�Fegu +ions of the San Joaquin Local Health_ District, r ¢�r/til` _- �, __Owner an Contractor) (Signed) inti f - j 'f�- (Owner _. -- ------ -------- - e `�' ---------( '` ) .� (Plot plans, showing size of lot, location of system in relation+o wells, buildings, etc., must be.filed 4 ith this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- __ Y-----------�-------- ------- - -- -------------------------- DATE +"e-{ - -- t t 776--__ BY---------------------------------- ------- ¢ DATE---------------------------------------------------------- REVIEWEDBUILDING PERMIT ISSUED--------------------------------- DATE - ------------------------- J ---�trl Alterations and/or recommendations:___,____ - ------ -- --=-•-- f k - - Q}5b, — ------------------------------------------------------ -------- ------ -----------------------------------I------------------' • -- ---'-------------- - -----`--------------------`Y-- ----------------- ------ ----3-------:-----------------------------------------------'------------ -`--------:-------------- - f T �r PERM o. _(a ISSUED-------- --- a `- 7------ (Date) FINAL INSPECTION BY: ---•-- _ ----- -- Date--------------- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , Stockton, California ES--9-2M 4-50 W=1639