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APPLICATION FOR SANITATION PERMIT $y A_ (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and,insfah the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-___ '7 h'm 41 /Y Owner's Name, ---------�� __ -e--t-/_ as---------- ------ --------C116WA10- 4 Address---------- 1_1�t ---- ------ ---------------------------------------/ Phone-_,O��-47FA- Contractor's Name ----------------------------- ------------------- ----------- -�r -----------E- ------------------------------------------------------- Installation will serve: Residence - ------ yx Apartment House E) --------- Phone- x Commercial El Trailer Court E] Motel F ------ Number of living units: J, ❑Number of bedrooms - ' ] Ofher E] 2;� Number of baths 0- Lot size_____.. -7 ------------------ Water Supply: Public system stem`system 0 Private Character of soil to a depth of 3 feet: Sand El Gravel ❑TYPE OF INSTALLATION AND SPECIFICATIONS: Sandy Loam E] Clay Loam ❑ Clay El Adobe Hardpan ❑ (No SOPfic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest No. of compartments-sf well-----------------Distance from foundation--------------------Material--------------------❑ ----------------------------- a ------------------------Capacity-----------------------Size------------- "----------------Liquid depth----------------- Cesspool: Distance from nearest well-------------- Distance from foundation--------------------Lihing material El Size: Diameter--------------------------------------Depth------------ ---------M-------------------------------- Privy: Distance from nearest welt______""___"__"___"__"_ -----------------------Distance from nearest building------------------------------------ El Distance to nearest lot line ,Seepage Pit: Distance to nearest well--Z. -----------D;sfance from foundation-2-V------- Distance to nearest lot line-- _Z5-- Number Of Pits--- ------- 01101��----------Lining material_--BA?JC4C--Size: Diam,fer__.SZ7" I Disposal Field: Distance,'-from nearest well_______--_-- Distance from --------------Depth-/-91-------------------- --- foundatio.n------------ ------ isfance to nearest lot line ❑ -----------------------------------Length of each �; —.. Number,of lines D line"-- cath ------- Type of filfe'r material____.____________________Depth of fitter material 0 frenc).7------------------------------------ Remodeling and/or repairing (describe)!-------4-PN77/4p ----------- ----------------------------------------------------------------------------------- . . .......... 4 --------------------------------------------------------------------------------------- ----------71'_Vk_a------M-0-VISAZZ ---------------------- ------ I hereby certify fy that I have prepared this application and that-_the work will be done in accordance with San_ _J_------- ordinances, St aws, and rules.an d,r?gulafions of the San Jo:aTuin Local Health District. q (Signed)---------- oauin County Ix-------- ts#- /------ -------- (Owner and By:-------------- Contractor) w .. .... . - -- - ------------- is application).'ca (Plot plans, showing s.- -A---------- - -- - -------- fle)size of lot, location of system in re ----------------------------(Ti --- ----- la on to wells, buildings, etc., must be filed this applicati/oni. APPLICATION'ACCEPTED BY---C-'. FOR-DEPARTMENT USE ONLY REVIEWED BY_ ------14;�--------------------------------------------------------------------------- DATE-- 'e- ---------------------------------------- REVIEWED BY------ D �r ---- -------- BUILDINGPER ---------------------------------------------- --------------------------------- DATE ---------- -------- DATE__Yti ------------ -- Alterations and/or recommendations:_______-___"_____""-__ -------------------- ---------- --------------------------------------------------------------- --------------------------------- --------------------------------------------------------------------------------------------------------------I------------------------------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------7------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ -----------------------i------------------------------- PERMIT Y -------- ISSUED------------tE --S----(--(Date) FINAL INSPECTION BY: ----------------------------------------------- -------------------- Date -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E5--9-2M 9-50 W-,109 Stockton, California