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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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A 22_--------- Y ----------------------------------------------- ---------------- -------------------- ND LOCATION________________ _ Hackberr _-_____---___---____ Owner's Name--------------------------------------------------C Sax-----COlumbx'O --------------- Phone----- `fig------------- Address-------------------• -------------------- 2204 H3Ckb_e_rrY---------------------------------------------------------------------------------------------------------- -------------------- Contractor's Name_______________________________ --------- A= PAR iISH--& DIV INC'------------------------- Phone------9!!_9_ -Qrj------------ Installation will serve: Residence KK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: a Number of bedrooms E9 Number of baths ❑1 Lot size_______�?_Qt___ ------------------------- Water Supply: Public systemXX Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® 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__OOODistance from foundation-10Q__-Material____-_a_ Uisting No. of corn pa rt menC1000eOQQ------Capacity-----------------------Size--------------------------------Liquid depth------------------------ -cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------- 'P -____Distance from nearest building ----- ,'-Privy: Distance from nearest well----------- ----------- --- ------- - --------- ------------ -------- ❑ Distance-to nearest lot line------------------------------------------------ t Seepage Pit: Distance to nearest well----Nb'�------Distance from foundation__ _____�Ot-__.Distance to nearest lot li25-f_ - ti ---------Lining material-_CC__BT1C Diameter-------3-3---------.Depth------------------------------- ® Number of pits------- ze: - Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line__--______-______ F,xMsting Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------------- -__ _--_ tary Remodeling and/or repairing (describe):__------ ___-_S_uPpDrl _ n - -------------------------- ---- - - - - - -- - --------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that l 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)_ P.A JS ON ---- C-------------------------------------------------------'--------------------(��Contractor) ---- ----------------- Title----------stimatu------------------------------- By: -- -- --- -- ----- f 1 (Plot plans, showi size of lot, location of system in re ,on to we buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------------------ ---------------------------------------------------------------------------- DATE---------------------------------------------------- REVIEWED BY-------------------------------- DATE--------- ---- BUILDING PERMIT ISSUED--------------- ------- ------- ---- ---- DATE ------------------ Alterations and/or recommendations------------------- ------------------------------------------------------------------------ ---------=---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------ ---------------------------------- ------------------------------------------------------------•------------------------------------ ---- --v --_------------------------------- - ------------------------- --- -------------------- ------------------------------ ----------- - ----------------------------------------------------------------------- ------ - PERMIT No. r1__- _ _ ISSUED----!`--_1-- '-- ----/--------(Date) FINAL INSPECTION BY-------------- j---�----- - -- - Datei -1 '-• ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W=1639