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A s APPLICATION FOR SANITATION PERMIT i' (Complete in Duplicate) >� 0 ' 6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described'. F This application is made.in compliance with County Ordinance No. 549. bane F�Ute 3=Box. JOB `ADDRESS AND LOCATION------Ea=0�7--- • ---------- ___-------------•------------------- t ------------------------------------ Owner --- F ------Edwar-d F�ed8r eekPhone Owner's Name..-------••---------------- - ------------------------------ -------------- k ---------------------------------------------------------- i ; 8c Bet,Ze� ---------•-------------��.�E'r-----------•-------...----- --------------- ------------- ----------------`-------------------.-.---------- --------------------------------------------------- Address , I ------- ----------------------------------- Phone--------------------------------- �• � Contractor's Name_..-----•---------------------- ---------- - Installation will serve: Residence] Apartment House-fl Commercial ❑"' T�6iler Court ❑ - Motel ❑' Other ❑ Number of living units: '[0 Number of bedrooms 5 Number of baths [1 Lot size____12�__X-- - -------------------------------- I Water Supply: Public system ❑ Community system ❑ Private' ] Loam ClLoam ❑,r Clay'❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Y , TYPE OF INSTALLATION AND SPECIFICATIONS: �• (No septic tank or cesspool permitted if-public sewer is available within.200 Jf eq c cr ete a' Septic lank: Distance from nearest well__fi.5__________Distance from foundatic,P_1�_-----------Material___________----------------___r f -- Ll X 9 -------Liquid.depth----5-------------------- No. of compartments--.--2-------------------Capacity -QQQ_ Sizet --- -- Cesspool: Distance from nearest well________-;_______Distance from foundation-t__.__��,______--Lining materiaL'______________________________- + ( ❑ Size: Diameter----------------------- Depth `= ', ' Privy: Distance from nearest well___________________________________--__________Distance from nearest bui in gF ❑ 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------------------- - ._._. K. 25 . Distance,to nearest lot line--1a i--�- Disposal Field: Distonce_from,nearest,well__;��J_________Distance.rfrom foundation_-____ - t: ] Number of lines_____ Length of each line___-------6Q.-________'_.Width of trench____2 -_-------------------------- k Type of filter material----Foc_ ,---------Depth of filter material__-____- Remodeling and/or repairing (describe)-:--- -N-e-w------------------------ -----------------'-------:::-----•-----------------••--------------------------- J ---------------------------------- -----------------------------------•------------------------------------------------------------------------------------------------- s ----- - -i`_ ,� ---------------•- — s ------------- - ------------------------------------•--------------------------- -------------------------------------------- — y —; I hereby certify that I have prepared this application end that.the-`work will'be done in accordance with San Joaquin County'4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District `.,_ t (Owner: and/or Contractor) 4 (Signed) -- -------- Title)--------- -----------------"-------------------------------- By:-----•--------- ---- - '----------------------- ----------------------------------------------- [Plot plans, showing size of lot, location of sysferh' in.relation to wells, buildings, etc., must be filed wiIh this application}. �DXTIE FOR DEPARTMENT USE ONLY ,APPLICATION ACCEPTED BY- -------------- ' -�-�- - � -- OL __ ` __r - ' __- REVIEWED BY------------------------------------------ ------------ ------------------------------------- , DATE 1 BUILDING PERMIT ISSUED-------------------------------------- ' ----------------- ---------- - • DATE__-------- -------------`'---------------------------•----- s - -- �-' Alterations and/or recommendations----------------------------------------- �.- >,- --n - ---- -- r ----------- - ---`•----------------------------- --------------------------------------- " " ----••------------- f --------------------- s i y - --------------- ----- --------------------------------------- t fit--------- -------------------------------�- --------- y l� L PERM17 No.�`-" �---jam 155UED------ 1_, �' ._ _.--------(Date) FINAL INSPECTION BY----- --- ------------ --------------- Date----------- SAN ISAN JO_AQUIN LOCAL HEALTH DISTRICT 130 South American Street i Stockton, California ,�� ES-9-2,M '9-50 W-1639 � s1 �,