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r APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ZW&Wt 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----------h--0-- y ----------------------------- -------------------------------------------------- Phone---�-Jo//_0----------- Owner's Name------------------------------------------a4l rt_ Address ------------------------------------------------------------------------------------------ Contractor's Name----------------------------------„'�--'`----- —------------------------------------ Phone----f�RS 6-Q--------- Installation will serve: Residence X Apartment House ❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms P� Number of baths [%- Lot size_%4r_'X-____�_ Water Supply: Public system Community system ❑ Private ❑ 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 19 Hardpan ❑ i 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_ Etl4r,__Distance fr foundation.-�_Q-�___-___.Material_--__C__i---( � _ a P -------------------Capacity-��CQ-----------SizeJ1__' ,,;47 _4_X6quid depth_J7.'��------__-_ No. of compartments Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Liming material-------------------------------------- 0 Size: Diameter--------- ----------------------------Depth--------- -------------------------------- 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------------ p 9 1-0- Seepage Distance to nearest lot line___#____ See a e Pit: Distance to nearest well � �__-___Distance fr foundation__ --Size: Diameter__ "- [ Number of pits-_-_---1-------------Lining matenal_C_� -� Depth---- -0-''---------------.-- �,Disposal Field: Distance from nearest well-11040-41111--.Distance from foundation__I__Q-!-__-----.Distance to nearest lot line____q�'�---- Number of lines--- ___ Length of each line--- ----------------Width of french--AY-1-1________---__--_- �r4 Type of filter material._II -21----�__k____Depth of filter materiaL___11 ii -- j4t 'Remodeling and/or repairing (describe):---------- 4o,---- ��-^'^' '-------------------------------------------------------------- r ------------------------------------------------------------------------------------- - ------------------------------------------------- -------------------------------------------------------------------------=----------------------------------------------------------------------------------------------- .. hereby certify that a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules nd regulations of the San Joaquin Local Health District. (Signed)----X- -*----- --- - - ---- �--- .-------- ----- -- ------------ -- Awe ontractor) By: * (Title) ""= -- ---------------- (Plot plans, showi ' e of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ "' = DATE - REVIEWED BY------------------------------ / _ ------Y---• DATE--- BUILDING PERMIT 155UED--------------- - -- _ �ff? � 0 - --------- DATE--C(------- -------------------- ---------------------- Alterations and/or recommendations-------------------------------------- ----------------- ------------------------------------------------------------------------- 40 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- PERMIT No----- ---- ISSUED ISSUED--- -( - - - -----------------(Date) FINAL INSPECTION BY-------------�Aj___M---------------------------------- E Date-- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES---9- 2M 9-50 W-1639