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APPLICATION FOR SANITATION PERMIT [Complete in Duplicate] q Application is hereby made to the San Joa uin Local Health District fora permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 549. , y ----------------- JOB ADDRESS AND LOCATION------------ 6-------- ----- 4t, jff--------- -10 -+---- --------- � h " � Phone------------------------------------ Owner's Name__________________________ `` p Address �+1. --- �' -1E4"-�4----"------•- Q�_ Q_ ?�Q�? --••---------- ---- fV. /2 07-------- Contractor's Name - � RR�S' ' �� zs� r - ------- Phone._ Installation will serve: Residence Apartment House El Co ❑ Trailer Court El Motel El Other El of living units: Z Number of bedrooms Z Number of baths Lot size______ ___?__"�__ Q_---------- Water Supply: Public syste' Community system [1 Private' WWI Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam El Clay Loam El Clay E] AdobeX Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] ��____Distance from foundation_____ f --Q-------.Material---�--��---------- --------------- No. , � Septic Tank: Distance from nearest wel_ _ a �, �+ . ,��g _ .-_�1-_LI Liquid depth---,V-,Z---------------- 4 Y + No. of compartments____________ �C�-----Capacity-9-00-��--------Size_ - G � ----------- Cesspool: Distance from nearest well----------_------Distance from foundation-------------------- Size: materia___.___________-_______ ❑ Depth--------------------- --- - ------------------=-- Size: Diameter-------------------------------------- - - - .Privy: Distance from nearest well------------------ ---------- ---- Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------------------------------------------------ , 1 Seepage Pit: Distance to nearest well_____ ______________Distance from foundation Number to nearest lot line_________..._____ INumber of pits--------------------4--ining material-----------------------Size: Diameter------------------------Depth--------------------------------- Disposal Field: Distance from nearest we] - Q�!�----Distance from foundation��S""--------Distance to nearest lot line- ------- I �-�- _---Len Length of each line------ of trench------ 'c_' ------------------- Number of lines________f_____ -- g "rte k Type of filter material__ .�-- ---`--pepth of filter matenal_________�_ __f`__ Y t Y Remodeling and/or repairing (describe)---- ---•- --- ----------••-------------.------------------------------ ---- ----------------- ----- -------------- ------------------- Cit? /iaS R l --Z-a�--------------- -- •---------------------------- .., ------------------------ -----------------I----------- -------------------------- ____________________ _____ __________ ________ _____,___________-_________________-________-__________-__-_____-_____-____________-_______________________-_____________________________.._______ I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County i Lnnes, Sta+ laws d ru is nd regula ions of th Joaquin Local alth District. .J fRla --",0,07S � ------------- -----[Owner and/or Contractor] ---- i� , ',�/1�'l�1Q (� 11. --------(Title}-_ns, show size of lot, location, ystem in relation to wells, buildings, etc., mus # be filed with this application). FOR DEPARTMENT USE ONLY --------------- APPLICATION ACCEPTED BY- DATE--;5---------------------------- REVIEWED BY-------------------- DATE z.--''I BUILDING PERMIT ISSUED---------------------- ------ DATE- 4e0 % ------------------ ATE �� ---------------------------------- Alterations and/or recommendations--------------------------------------------------- -------- ------------------------r ------------------------------------------------------------------------------ ----------------------------- ------------------------------------------------------------------------------------------- PERMIT No. _ ED.ISSU9 / (Date) FINAL INSPECTION BY:.------ V#------------------------------ rDate_ - � �--•---��-- �---------------------------- -SAN --------------- ---------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California s ES-9-2M 9-50 W=1639