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APPLICATION FOR SANITATION PERMIT s (Complete in Duplicate) _ f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ordinahce No. 549. JOB ADDRESS AND LOCATION--------------50---Aon---GertxU_de---Street------------------------------------------•---------------------------------------- Owner's Name-----------------------------------•------------E-dwa.1^d '=-- Xe-a,1ingy------------- --------------------------------------- Phone------NQ------------------------- Address-----------------------------------------=----------------- ------san- JOaq n trEe- -------------------------------------------------------------------- _ Contractor's Name----------------------------------------D&---A-----PARRZSH & SC HS,--1T C_s--------------------------- Phone__9_-?kQ?--------------- Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [I Number of bedrooms [2 Number of baths I Lot size------5Q__1__x11Q--------_-------------------- _ Water Supply: Public system [X Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ 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_________________--_-----_-______-_____.________- �[\ C*xj.sting No. of compartments--------------------------Capacity..---------------------Size-------------------------------Liquid depth-------------------------- R. Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_____-________--_-__________________. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- ,Privy: Distance from nearest well_______________________________________ --Distance from nearest building_________________--_- _-_____________. ❑ Distance to nearest lot line________________________------_---.____________ C '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__Vj0n?_-_Distance from,foundation__.12t-_____---Distance to nearest lot line -- - [� Number of lines--------------- .._________________Length of each line----------50_!------------Width of trench_:____Z _.__._____-_-_-____ I Type of filter material____-.1PI11----Rk---Depth of filter material---lall-_____-_---- Remodeling and/or repairing (describe):_________ pPl ffiet3----_ --o-_-dr----- SxB1v@mid -------------------------------- ---------------•--------------------- -------------------------------------------------- - ------------------ -------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicatio 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)---- -- t------ -0 - #----- -------"-------------------------------'---------------t---------------0--------------(au"pWontractor) :. By:--- ----- ----- --------------------------- - -----(Title)_E e lmato r--------------------------------- --- - - (Plot plan , show g ize of lot, location of system in re ion o wells, buildings, etc., must be filed with this application). FA DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_----------------------- -- --- ----- -- _ ------ DATE------ REVIEWEDBY------------------------------•----=---------------- - --- --------------------------- DATE---- -------- --------------------------------- BUILDING -- -- BUILDINGPERMIT ISSUED-----------------------------•---- ---------------- ------------------------------------- DATE-----------•------------------------------------------------ Alterationsand/cr recommendations:----== ----------------------------------------------------------------------------------------------------------------------------------------------------•--- •-----------------: --------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------•---------------- ------------------- -----�----------- ----------------------- J --------------------------------------------------------------------------------- ------------- PERMIT No��_ ---.__r_------ ISSUED__-- ----, -------_.__1__--------[Date] FINAL INSPECTION BY:-----------_-V___111-----------------------------•--- r Date -- ------- s. P SAN JOAQUIN LOCAL HEALTH D15TRlCT 130 South American Street Stockton, California ES-9-2M 9-50 W-1631?