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r APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) k 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------------- 21_.Id-� er_ ruds Owner's Name------ZQ-U---A-1_J-1Slar1tJ------ ---------------=---------------- ---- -------------- --------------------------------------------- Phone----na-------------------------- ---------------------------------------------------------------------- ----- Address-------------- Contractor's Name------Be_lta------------------------------------------------------------------------------------------------------------------------- Phone---3�'3 }---------- l I Installation will serve: Residence)] Apartment House El Commercial El Trailer Court El Mole[ El Other ❑ Number of living units: -[2 Number of bedrooms ❑[ Number of baths-1-1:. Lot size--------50-x-200_.---------------------------- i Water Supply: Public system ❑ Community system ❑ Private [] :. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ �t N . ft TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-----�0_-----Distance from foundation__a_-------------_Material__b�I.P____------------------------------ - �] No. of compartments-----------2------------Capacify__'_'8QQ---------Size---------------•----------------Liquid depth----------------: _----- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-______________________________-_-__. ElSize: Diameter-------------------------------i-------Depth---------------------------------------------------- Privy: Distance from nearest well_____-----':___________._ __i-__--Distance from nearest building_____------------------------------------- El ___________________________________❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______-...______ ❑ Number of pits----------------------Lining material.----------------------Size: Diameter------------------------Depth--------------------------------- Disposal Field: Distance from nearest well_________________Distance from foundat' .5 ._-__Y Distance to nearest lot line-_ 5 --- Y. - f t Number of lines------.--�-----------------------Length of each line----------------•-.-------.._Width of trench-----�•PP-r- ------------- I Type of filter material----roCLk----------Depth of filter material---18.............. x Remodeling and/or repairing (describe)-------------J1ew---in&-tal-lati_tQ17.------------------------------------------------------------------•------------------------•-- ----------------------------•--------------------------------------- ------------- ------------------------------------`--------------------------- ---------------------------------------------------•-------------------------------------------------- I 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) _______Owner and/or Contractor By:----- ---------- •,T_er_r_-`4 art, ----- - --- ----- � [Ti+le} D�tn�x- �' --------------------------------_ - � -— (Plot plans, showing size of Ivt, location of sy .em in'.r atio wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------------------------------ -------------------------------------- DATE -- -- -- -- --- - a ------------------------ REVIEWED BY------------------------------------------------ ------------------------------------------- .ZDATE _ BUILDINGPERMIT ISSUED-------------------------------------- --------------------------- ------- DATE---------p ---------------------------------------- Altera+ions and/or recommendations--------------- -_-- �- -----0 ¢' �`rf' O11�_?�c---No` '---------- ------------------------------------------------------ 1 - --------_- --- -- - ------ ---------- -- - -------------- ------- ------------ - -------- ► •� -,A'47?------ /_d_� 1 �='.- 0-4----- ,-^ ------ ----- / �t --------------------- ------- "-------------------------------------------------------- V 3 �3 �`/-----------(Date) FINAL INSPECTION BY-------- ----------� = PERMIT No. ISSUED ' Date----------------------- "" ------ ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2W.9-50 W=4639