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` APPLICATION FOR SANITATION PERMIT �i (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for"a permit to construct and install thework herreei�escribed. PP549. p 8r5` • Ordinance No. This application is made in compliance .with 7 f � xrali.Ae__.Add__,-_:oa � ec : 1 JOB ADDRESS AND LOCATION3s __Te � �---� - �-L ----------------- 6: `_ K, Shippee & o,��ia710 Lane Owner's Name-------- �' � ►�R E S_u 3._t� .3-1---- hone - Address---------82-8 i' Zo ',A�Q�$ �' '-lit clxr C lef -------------- Phone______ - 3-39-5-5-------:-- •Contrac+or's Name-----------_IlP-1t2------------------------------------------------------------- _installation will serve: Residence [51Apartment House ElCommercial ❑ Trailer Court ElMotel ❑ Other ❑ -- Number of living units: M Number of bedrooms 21 Number of baths [I- Lot size----100N,2162------------------ " Community s stem ❑ Private 9 Wafer.";"Supply: Public system ❑ Y Y , . Adobe Hardpan t Character of soil to a depth of 3 feet: "Sand ❑ .Gravel ❑ Sandy Loam ❑ Cray Loam ❑ Clay ❑ p ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) D.istance."from:,founclation_a»0t----- ___-Material__c '=1 '� "b 'i [ Septic Tank: Distance from nearest well___&_� Sizei_ till�------Liquid depth_ 4-��>_ ---- No. of compartments--- -2 Capacity ��- ____ Distance from foundation _ __ Lining material Cesspool: Distance from nearest well nearest well__--_--------------- De ---- 1 Privy: D stanDcle frotmr pth_____________________Distance from nearest building ------------- Distance to nearest Iot line-_;___-"______________________._ - from foundation____________________Distance to nearest lot line-__- _____----_ I t �g pit: ------------ ____--Distance :_-_ e Distance to nearest well ________° - Seepage Number of pits--------- '----- Lining,1material ce from found ize: Diameter-----------------------Depth-------------------------- ation_- -=-----------Distance to nearest lot line--IQ.------- ❑ :p, 1 ------- Disposal Field: Numaber from nesearest we--------_- Length of each line-____ _fl______ ---- ------Width of"trench_ �---------------------- ---- Type of filter material____-1^_D-C-'i-------Depth of filter material-_18!"_____________ Remodeling and/or repairing (describe):------------------------[ Y I-as_ta,11111c----- 3 _H s� ?xl------------ ---=- ----- - x- ------------------------------------------------------------------------------------------;---- ---------------'-------------------------------- ------------------------- ------------------ ------- ,-----;---------------------------------------------------------------------------------------- I hereby certify that I have prepared.this application and that the work will be done in accordance with San Joaquin Count nd regulations of the San Joaquin Local Health District. ordinances, State laws, and rules a ! Delta ry -------------------(Owner and/or Contractor) ---1,e�..�..a,---- ------ ----- -. 1 (Signed) Owner i''-------------------------- Title sy:__ .r ---- - - ---------------------- (Title, --p r+ z r (Plot plans, showing size of lot, location of r ste in relation to wells, buildings, etc., must be filed with this application). FORD ARTMENT USE ONLY j DATE------- APPLICATION ACCEPTED BY-- DATE---------------------------------------------------- ---- REVIEWED BY------------------------- ----- ---. BUILDING PERMIT ISSUED------------------------------------------`---------------------- -------------- DATE----------------- -------------- ----- ---------------------------- - -------- - ---------------------------------------------------------------------------- Alterations and/or recommendations------------------------------------------"--------- " __ ------------------- ---- ------ ------- ----- ------- -------- ------------------ --------------I--------- -------- --- - . -----------------I--- -- ------------------ - --------- l -_(Date} FINAL INSPECTION BY:._____- ' PERMIT No._ _r�--J_L-----� ISSUED-- -- --=-"�-----�- - �- -------------�--------. �"" I�' { I Date--- - -----------��- --- SAWJOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639 `