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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 co struct and install the work herein described. This application is-made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---•----------------�'�� • 5rr.�?c'.'t;-o .0.__Cal*----------------------------------------- . { .Owners Name............. "-------=-='----------- - -------------- ----- ------------ ------ - ------------ Phone------��-I7�S�`------------------ ' ------ 1 N' r x!acne Ade_._ 'a ----------------------------------------------------------------------------- Address-------------Contractor's Name------A•A'_---]?8_r;~'J,.5h--- --------- ---------- ----------------------- ------------ --- Phone-B-8,591----------------- Installation will serve: Residences Apartment House F1Commercial ❑ Trailer Court E] Motel El Other ❑ Number of living units: ❑ Number of bedrooms 91 Number of baths Lot size---- -�.__�-- -------------------------- Water Supply: Public system ❑ Community system ❑ Private Ila U` soil to a de th of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay [:] Adobe® Hardpan ❑ Character of p 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 _ _ _----------Material __Canaree--------------------- ----__ �_ e � No. of compartments---- � ll -- ' -0 Siz --- - -1_� _tiquid depth--- 211--------------- --------- --Capacity } # Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- Size: -_-_----_-_-----_---_._ - Size: Diameter--------------------------------------Depth--------------------- ----------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to_nearest lot line------------------------------------------------ 1 Seepage Pit: Distance to nearest well-----1-0.01-___-_Distance from foundation-____iQ-_---Distance to nearest lot line------8----__- Number of�pits-.------ 53 '_ ---Lining material..C4-6r Diameter.--3T'-----.-----.Depth----2Q-------------- ------- ' �t Disposal Field: Distance from nearest well_----_-59_:_-_Distance from foundation----l�_---___-.Distance to nearest lot life-._F- -____-.-__ �� -----------------Width of trench---------24"=='i=---- ----- Numb& of lines__--___Q1144"-------------------Length of each line_-_._ - - ® Type of filter material--- ry.....YQ!*,Depth of filter material_ ------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------'------------------------------------------------------•-------------- ----------------------------- ` , •� ------------------------- - --•-----•------- ----------------------------- --------•--------------------------------------------------------------------------------------------- - ----- -------•---------------------------------------------------------- - -- - --------- -------- - 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., : r D--AA (Signed)----------- -- ---�� _T_�.13�7,.--� - -4Tf .-s--- n-Q-�---- - ---�'-- -'fl��'&�'�i)I"--------------------------------[Owner and/or Contractor - Title}-----P��i�!X1'1"--------------------------------- (Plot plans, wing size of lot, location of system i s elation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --- -------- ---------- --------------------------- DATEf --------------------------- ��--=-�.��-` ---------------- --------- � Z• a` '----------------- - .,REVIEWED BY-------------------------------------� ._-f--={---------------------------------------------------------------- DATE--------- � BUILDING PERMIT ISSUED------------ - r�".�_ -=_ DATE-..- = �'` = o Alterations and/or recommendations -------------- _ t -------------------------------------- ---------------------------------------------------------- ------ - -------------------------------------------------------------- - } PERMIT No-------- ----------I' ISSUED-----4 --s}'-_N-R5-P--(Date) FINAL INSPECTION Y:-- -' - ---- ,j 1 ------ - � - Date--- -- (�, --------------------- I i SAN`JOAQ.UIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639