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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 AND LOCATION--------- ($R---, o.-,-2__,youth--Eit7kley---i----S-tack.t atackton---------------------- Owner's Name----------------------------------------XM=---C-tr-o---AGOd y--------------------------------------------------------- Phone--!t-159Q-------------- Address-------------- --------------------------------------a82Q--R.--.Washington--Street Contractor's Name---------------------•-------.....:D-�---Aa---- ARRI.9R---&--- OT B-T---1h1C-------------------------------- Phone----9n960 -------------- Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: Number of bedrooms &I Number of baths E:L, Lot size----------6Q,x:Lll+t-----------___________________ Wafer Supply: Public system Community system ❑ Private ❑ I I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeXX Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: M .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well____5Qt------Distance from foundation___101-______.Material-_-____C___C___Briak_______________ 800 G--- " " se [x No. of compartments---------2--------------Capacity-----_________-___-- Size_��__�6-__K�3-.Liquid depth---------52«----_-•--. Cesspool: Distance from nearest well-----_-----------Distance from foundation--------------------Lining material__________-_____________-------------------------------------- I ElSize: Diameter--------------------------------------Depth---------------------------------------------------- :Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-________----______________--_-___-___- t ❑ Distance to nearest lot line________________________________________________ 'Seepage Pit: Distance to nearest well____ZOQ1------Distance from foundation____-2Ct------Distance to nearest lot line__�O�_____,_ ® Number of pits-------1------------Lining material.Q{;-__3rjcj6ize: Diameter--------33"--------Dept h------------20t----________ Disposal Field- Distance from nearest well___6Ct-------Distance from foundation---3-9_---------Distance to nearest lot line___-1Q=-' ® Number of lines---------------I�Ff_-___-.____Length of each line-------------20 t_____-_.Width of trench___._--24"------------------- Type of filter material____�_;�__----Rk--Depth of filter material------18�t__---_-_ Remodeling and/or repairing (describe):----------Re-W----installat_iQn-%-x------------------------------------------------------------------------------------------ t -----•----------------------------•---------------------------------------•-----------•---------------------------------------------------------------------•-----------------------•---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 rul and regulations of the San Joaquin Local Health District. (Signed)-------DA. P _ _0SNS-r--_1xC-.-.-------------.----------------.--------------------------------.------------( Contractor) BY:--------- - -- 14 i'� : ----------------------------------------------------------------(Title)_Estimator------------------------------------- (Plot plans, sho i g size of lot, location of syst m�in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE----Z REVIEWED BY � �------- ----------------------------------------------------------- DATE---- i$li� BUILDING PERMIT ISSUED--------------------------------------------------------------- '' ----------- DATE----- -- Alterations and/or recommendations-----------------------------------------------------------------------------------------------•---------- i -------------------------------------------------------------------- ----- -------------------- -----------------------------------------------------------------------------------•-------------------------- PERMIT No.-----S-�- ---------- ISSUED------ .. � I--------(Da#e) FINAL INSPECTION BY:------------------IZ_� ------------------ r- Date----------------------- -------�-`-�------ -------------;----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California H-9-2M 9-50 W-1639