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APPLICATION FOR SANITATION PERMIT 11�3 (Complete in Duplicate) i Application is hereby made to the San Joaquin Local Health District for permit This application is made in compliance with County Ordinance No. 59. l p mrt to construct and install the work herein described. JOB ADDRESS AND LOCATION_-_______-_. ' 2zf-�E2_._x7Q�.-��.a Owner's Name__.----pe�6---ped&rid 3------- ------------------------ f "Address..-----1 Hart1 ,� .519_-�-_ Lard aY, 3�� •_ ---- Phone_RrX243_-Nttl_. aYy �t -_sr t �l ,f .- Contractor's Name___-�jaB Installation will serve: Residence lrl-.Ta.nk Sex-- -1ce----_----_---`----- ------------------------ile -- Phone-_3-3.95 _ ` ® �Apartment House ❑ Commercial ---------------- Number of living units: El Number of bedrooms ❑ Trailer Court ❑ Motel ( Number of baths t ❑ Other ❑ Water Supply: Public system Lot size.140.._--x--65 t Character of soil +a a depth of 37feeto Sandmur"[I E] Private ❑ ' =Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ globe [n }-lard TYPE OF INSTALLATION AND SPECIFICATIONS: Hardpan El (No septic tank or cesspool permitted if public Septic Tank: sewer is available within 200 feet,) }� Distance from nearest well Distance from foundation__-__ No. of compartments_._.- �.t Material GQrLCx'ee-._. Ces o Capacity Distance from nearest well 8.00-__-----Size---9! _��{�r ------------ 'a- --•---Liquid depth----4------ _-___-._Distance from foundation-------- ----------Lining material_------_ r. Size: Diameter______________ ------ P rDepth m from nearest well.--------- --------------------- Distance to nearest lot line __ Distance from nearest buildin 9 ------------------------------------ Number ---------------- epege Pit: --- ---- ------ rstance to nearest well___---�_____________Distance from foundation-_- -� Number of pits----- •-----__-__Lining material_-.-brick / ------- Distance to nearest lot li e__.- --------- Disposal Field: Size: Diameter------ s" Distance from nearest well from foundation--_:_ Q�_--- Distance to nearest lot fine . } Depth- Number of lines__1_._____ 1 Type of filter material_�_� -- --`--- Length of each line- _ lo, �Nidth of french------------ °-,o r___ F �' -Depth of filter material-----_--/$'E i Remodeling.and/or repairing (describe):--___-_- ,� �t 1 ----------- - ----------------- ) � ,Ne: --- -- a �.aeon------------------------------ ------ ---- --------------- --------------------------------------------------•--- 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 rules and regulations of the Sart Joaquin Local Health District. (Signed)------------- l By:_. .__ (Owner and/or Contractor) - ------------------------------------ ------------------_(Title) Ot}ner--M (Plot plans, owm si o o}, loc ion of system in relation to wells, buildings, etc., must be filed with this application). ' • FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY--- REVIEWED ------- -------------------------------------------------- _ ___ ______ ___ --------------------- - 1 DATE -------------------------------------------------- ------------------ DATE--- - 1` ---------------------------------- BUILDING PERMIT ISSUED Alterations and or recommendations:- -` ydp - ------- - 1 DATE ` I -- r �_ ' fel - / <n P� �, . ! - �► �-a. A7 r his..- g ----- ------- 1QP-l_f � ---------H o P�----- a- COttf.PJI t- y - . �L__ , �------------- � ! PERMIT No....... \_�--------- ISSUED-----1-[ - g " S' -----------(Date) FINAL INSPECTION BY: ---------- -/�� V r t , f Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' ES-9-2M 9-50 W-1639 s Stockton, California l