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* APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Dis#riot 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--------------------3$38__Harnex'------------------------------------ ------------------------------- Owners Name-------J_ W Td-,Y'ren--__ Phone___- -018---------------- Address----------707-,B--•--- y------------------------------------------------------------------------------------ --------------------------------------------- Contractor's Name----- --------Ati_If.fit,-------------•--•----------------------------------------- -------- --------------- ---------------- - -------- Phone--3--3955--------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:j] Number of bedrooms E. Number of baths M Lot size------4Q!nX7n9_Q____________________________________ Wafer Supply: Public system .K] Community system ❑ Private ❑ w`r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sceptic Tank: Distance from nearest well-________________Distance from foundation--------------------Material_------_________________---__________________- ✓ L©J.sting No. of compartments------2-----------------Capacity-100 ---------Size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well_______________ Distance from foundation-------------------.Lining material______.___-___________________---__ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well------------------------------------------------- from nearest building______.-------__________________---------. ❑ Distance to nearest lot line------------------------------------------------ IF 44 Seepage Pit: Distance to nearest well----------------------Distance from foundation_' Q____-------Distance to nearest lot line_,__ __---- Linin material-_-bre Ck Size: Diameter_______________ _ _____De th__________-- _______________- E] Number of pits_______�r___-___-___ g p .-Disposal FieH: Distance from nearest well________________.Distance from foundation_______________--__Distance to nearest lot line----------------- 20 Number of lines____________1-------------------Length of each line__50r ft-.-______----Width of french---P-P-------------------------- Type of filter material---x'Q_0_k----------Depth of filter material____16_n____________ -Remodeling and/or repairing describe ---------------re. ir-9. -------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- -- - - -- - - ----- - --------------------------------------------------------------------------------------------------------------------------------------- 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 +he San Joaquin Local Health District. Dr`1,t a-_S Eft C__Tank E C'V- - -- ----�------ ---------------------------------------------------------(tuner and/or Contractor) 1 (Signed)--:---------- �y� Perry `rVax'than _ - ---------------------------(Title) Ourx� r-- r ------------------------------ (Plot plans, showing size of lot, location o syst in a ion to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -=- ----- r ------------------ ---------------------------------------- DATE-------- a A REVIEWEDBY----------------------------- - - -------------------- ------------ DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------- ------- DATE------------------------------------------------------------ Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ---------------------------------------------------- ------------------------------------------------------------------------------ 9 ------------------------------------------------- - --------------------- PERMIT No.._✓__l------------- ISSUED-------7V/-rz�l---------(Date) FINAL INSPECTION BY:------ __ ------------------------ Date-------------------- --------------Date-------------------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W 1639