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r? � APPLICATION FOR SANITATION PERMIT G i . (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. �L/ ry4y --,p e_�4,fo/t,6 l �7__t _� --------- U��-------------------------------------------------------------- f I LOC ON 's' = - -3'7.rf3 JOB ADDRESS AND �j - (1 !/✓- � �.S` - --------- Phane Owners Name..-----------------------It__ kyr,. ---------------------------------- Address---------------------------------------------------/i"4--G-- Contractor's Name_______________________________ __ " - -------------------------------------------------- Phone----------------------------------- J Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units/Q/Number of bedrooms 9 Number of baths IX Lot size___ _________----____ Water Supply: Public system ❑ Community system ❑ Private � --V�'y� . Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam ❑ Clay El Adobe Hardpan ❑ 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__.&r3-----Distance fropp foundation_.-.��?---------.Mater• I___.`--------P_0ocCL.a--- ----_- .Liquid depth___-._-'�"- ° No. of compartments--------- ----------Capacity---- ---------- Cesspool: Distance from nearest well___-"______.----Distance from foundation-________--_____._.Lining material_____________________________ i ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well___ __________________________ _____"_________Distance from nearest building----------------------------------------- ❑ Distance to nearest lot lin'e----------------------------------------------- Seepage Pit:/ Distance to nearest well---------------------- from foundation-----------------._.Distance to nearest lot line___.___'.____ "_ ❑ Number of pits----------------------Lining material-----------------------Size: D,iameter---- Depth _ D.ispos Field:,, ": Distance.-.from neare.sf�well__� _..Dis#ance_from foundation_:_: - -Distance-Jo-nearest;lo.t:line-r�--.`_-___._.: _ Length of each line-- -------------Width of trench------- -------- Number of lines._____-.9' '--------------- g Type of filter material___ .--------_Depth of filter material______-,--�_.__ 1_ Remodeling and/or repairing (describe___________________ -------------------•-------------------------------------- ---------------------------------------------------------- ---- ----------- --- -------------- ihereby certify, t I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, Stat , and rules an gu tions of a San Joaquin Local Health District. ------------------------- ___(Owner and/or Contractor) (Signed) -- - ----- --- - - -- -- -- e By:.--. ---------------------------------------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). l FOR DEPARTMENT USE ONLY ------------------- APPLICATION ACCEPTED BY_______________________ " "--- DATE____ .-"/3 DATE = r REVIEWED BY - ;---_--�- ------------- e¢- /o ----------------- ------ DATE---- l�. $UILDING PERMIT ISSUED------- ,. Alterations and/or recommendations:_--- -.-^ ----- Y --------------------------- -----•- ------------- - -- - ---------------------- ----------- AAl-------- ' ------ ---------------------------------- --------49�------------------------------ --------------------------- -------------------------------------- --------------------------------------------- Date FINAL INSPECTION BY:-------•------------------ ---••------------------------------ PERMIT No�------------- ISSUED_ ----- -- ----• ----3"� -.-(Date) . -----------------------------"------------------- Date------------------------------ , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 y