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.a:f r APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Jo A Local Health Mstr',ct for a permit to construct and install the work herein described. This application is made in compliance with Count`�r. nce No. 549. k ------- > p� Phone -------------------- JOB ADDRESS AND LOCATION--- -------- Owner s Namei_ rr -------------------------------------------------------------------- - Address------ �J -'---------------------------------------- ---------------------------Y------- --- -•----- -- - ---- - --�------------------------ ___ Phone----------------------------------- - ------------------------------ Contractor's Name__..�� p ""'`� Motel ❑ Other a Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ Number of baths Q "" ' _ Number of bedrooms �_ Lot size____7t`*__._}�___, _,?�.--""------------- Number of living units: �❑/ ; Water Supply: Public system i Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20D fest.) Septic Tank: Distance from nearest well_________________Distance from foundation.___l'�.--------Material___-____. _______ -.____-__R C No. of compartments--------- -----__.-Capacity--��a--------Size__ ..`k/o-- --' ---Liqu,d dep'rh------------'.---------- Cesspool: Distance from nearest well________-___'---Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter------------------------------;-------Dept ------------- ------- ----------- --------- ---- Privy: Distance from nearest well--------_----------------------------------------Distance from nearest building----------------------------------------- ❑ 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:.Diam�r-- -------------------.Depth _ -- ❑ - Disposal Field: Distance from nearest well____________ __.Distance from foundation--------------------Distance to nearest lot line,__ # _Len th of each line_____-.S`p-_��------Width of trench------- ----- Number of lines__________" g _ _ ---------------- Type of filter material___._ c3 _Lth of filter maternal____________________" t. _______________•_____-___•_--____.-_____-_-_•_________-____________________________.__-____ ____..________ Remodeling and/or repairing (describe):___.""""____________----------------------- , - F ---------'------------'----•------'----•-----""---------•------------•--- -------------------------"---- _-- --------------------------------------•-------------•----------------------------------.•--------------- - ------------------------------------------------------------------------•-------------------------------- _ ----------------------------------------------------------------------------------- --------------- a 1 hereby certify that I 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 Joaqu`in,Local Health District. .,00e 7.-s /e J ( _ er and f or frac �� "` I� (Own Con to (Signed) - -_ `1� ----------------------------------- -- - - j � ! - .� ,,�';�_ �.;_,--"".---- ----------------[Title]--------------------------------------------------------- By: ------------------------------N �01 d BY: :_ .r---------tea - (Plot plans Osj owing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ''`� ` i� -- ---------------- ------ DATE ------'��-f ;�------------------------ �} ,:` � .c-�-a- - -- DATE---------------------_�-----------------------•--------- REVIEWEDBY---------------------------- ----------------------------------------------------------------------------------------------------- DATE---- BUILDING PERMIT 15SlfED---------------------- ------------- N!F ,- ec ------------------------- ` � fl"✓.!J -----�tl c.'I`I n-�------ v�i•--- --------- 41,--/3�./a,aY --------- ------------------------- Alterations and/or recommendations:________. -_ - - __ " _ ��1�, tet _s. r_T ---------------------- ------- - -------------- ------ --- --------- ---------- .571, 14 - --------------- ------------------------ - ---------------•------------------------------------------- --- -------------------------- (Date) FINAL INSPECTION BY-------------- -----:`"'------------------- PERMIT No.-- --�-��--------- ISSUED----a--"��-�--5�---- � - ,1_ Ft Date_ --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT a •'F 130 South American Street *• Stockton, California ES-9-2M 9_$O-, g— ",. '' r