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APPLICATION FOR SANITATION PERMIT , # A (Complete in Duplicate) 1 ,rte 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__Hxa��__� e-,---F�� _�___ __- y r �$ @ Owner's Name-------------------E'd )rid---Fr_!;_afl-7._Dk.----------------------------------------- -- ------------------------------------ Phone------------------------------------ Address---- _-?------------------ - --Address---------------R._3..8_ox__25,---' ' k i 1 ----------------------------------------------------------------------------- ------------ --------------- Contractor's Name-----Beniz-ex----&_-Better---------------------- 1 k f r ---- ------------- --------- Phone------- -------- Installation ---------------------- Installation will serve: -Residence 'r*1 Apartment House❑ Commercial ❑ "Trailer 'Court ❑ Motel ❑! Other ❑ Number of living units.3D • Number of bedrooms Z:1 Number of baths m Lot size______12.�3.__ Water Supply: Public system ❑ Community system ❑ Private ( r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ti Clay.Loam.❑�\CIayb❑ Adobe ❑ Hardpan ❑ ' ;aa �� 1 r 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---------6-5___Distance from foundation---l;�-----------Material______L'l3Slo�G' i�__________________, Y It No. of compartments------2---------- Capauty lUfl� g ---------------------Liquid=depth--b Cesspool: Distance from nearest well-----------------Distance from foundation`__-_-_- --------Lining material,_-__________--_________-___________ ❑ Size: Diameter--------------------------------------Depth------------------- ------- -- .Privy: P Distance from nearest well_________________________________________________Distance,from nearest building A________-_____________----_.___-_ ; ❑ Distance to nearest lot line------------------------------------------------ Seepage _____________________________________________ _Seepage Pit: Distance to nearest well____X�------------Distance from foundation---!` ___. ____.Disfance'to nearest lot linelyo_____ Number of pits----------------------Lining material-----------------------Size: Diamete`r----------------�f----.Depth--------------------------------- Disposal Field: Distance from nearest.weil•__6.5______>__.D-istance,from,f-oundationr--;,5____�__Distance to nearest lot line____ _5_-.___ Number of lines------2--------------------------Length of each line-----6-0-----___-_--__-`_ Width of #ranch--2-"-------T-----`-------- _ - Type of filter material-RQS+k------------Depth of filter material----------------------- Remodeling and/or repairing (describe)_____________________ I -------------------------------- __________________ --------------------------------------------------------------- s t # hereby certify that I have prepared this application'and that the work will'be done i an ccord-ance-witiTSan Joaquin-County ' ordinances,,Stafe Iaws, and rulesyand'�regulations of the San Joaquin Local Health District. %`�f k (S-- �\ _ igned)•_' --------------------------------------------------------- (Owner and/or Contractor) ----------- and/or =_ 'F- le ----------=------------------------------------------------------------------(Titf - ----------------------=----- ------------------ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application), FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED�BY ------------ . T-- -- ------ ------------------------------------------- ----------- DATE i '------T ------------------- �� ,: oati• '►:,REVIEWED AfE f BUILDING PERMIT ISSUED-------------------- -- ------- -------------------- :--= -------------------------------;`-------- Alterations and/or recommendations-------------------------------------------------------------------------- = ---------.---------------- l ---------------------------------------------------------- // 7 ------------------------------------ --------_______ __________„__..____________ _ -------------------------------------------------------- ____r________________________________________________.------------------------ _____- _____________ ____________________________------ -- ________________-_____________---______-_____ PERMIT No. ----- -------- ISSUED------------- y� �j�__.---(Date) FINAL INSPECTION BY:---- --- _ ' ///Date------//----- ----7 / y� �'.SAN,JOAQUIN LOCAL HEALTH DISTRICT }/ 130 South American`Street Stockton, California ES-9-2 M �50 W---1639 [