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APPLICATION FOR SANITATION PERMIT U (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construcf and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOBADDRESS AND LOCATION- � 2 �= hf #te qtr_ . �t0_ck4n Owner's Name -------------------------------Q+----V----yA1r -0Ck--------------- =-------------------------------------------- Phone------ '_2-966------------- Address-------------------------------------------------------------2-5-u---E.....Lafaye-t-t-e---Stlraat----------------------------------------- Contractor's Name----------------------------------------R. A'-- F X7i Sh--& 5 ans K7��= Phone9..-r-96-07 F--- - - Ks' 2 a� Installation will serve: Residence E] Apartment House E] Commercial El Trailer Court 1:1 Motel El Other Ek apts Number of living units: . Number of bedrooms E3 Number of baths IN Lot size---5Q - --a.2� _______________________________ Water Supply: Public system EX Community system ❑ Private ❑ 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.) Septic Tank: Distance from nearest well--NZle--_Distance from foundation------ ..51------Material.---__C__ --$rjak__---__ J No. of-compartments--------2---------------Capacity--12QQ---G----Size_5&_x3.j"ems7_0"Liquid depth-----5 n L11 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---_-_----------___--- El Size: Diameter---==---------------------------------Depfh---------------------------------------------------- Privy: Distance from nearest well------------------------•------------------------Distance from nearest building ❑ Distance to nearest lot fine_________________________ ----------------------- 5 Seepage Pit: Distance to nearest well-------No-ne----Distance from foundation__3.5!----------Distance to nearest lot line_-_5!--__ KI Number of pits---.------Z---------Lining material-AC---C_-_BT_:L : Diameter----33'1-----------Depth--------20.1----------------- .Disposal Field: Distance from nearest well-----lime.Distance from foundation___L5t-------Distance to nearest lot line---_.51__-._.-- Number of lines-----------1---------------------Length of each line----------'751-------------Width of french------_24"!---____------- t Type of filter material-------l�ff___RkDepth of filter material_-_----1 L 'Remodeling and/or repairing (describe):---------------------------- ----------------------------------------- --------------------- ------N��ryns ally-t in fQ ' 1 sr�a1 ----hot�lsP_---aril--2---apps,.------------------------------ -------------------------- a c . _s-t-ing---yes -- -------------------- -------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 San Joa in Local Health District. (Signed)____ )-. A ' 9 H--- - ----- ( Contrac+or) - - BY� (Title)-- ---- Es t ima t or (Plot plans, owo lot, location of system in relati + wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- v -------!_- ------- ----------------- DATE- - ---------------------------- REVIEWED BY • -- --------------- -- --- ------------ -- --- -- - ---- ---- ----- ------ DATE--- ----- '�' BUILDING PERMIT ISSUED--------------- ------------------------------ --- ------------------------- DATE ---------------- ----- ------------------------------------ _______________________________________________ - -------------------- -----------------•---------------- ---------------------------------------------------------------- Alterations and/or recommendafions: -------------------- ----------------------------- ----------------------- -------------- ------------------------------------------------------------------- ------------------------------------ ----- --- ----------------------- PERMIT No.------ 20--_ ISSUED------------ --- a--7- -_ (Da+e] FINAL INSPECTION BY:---_ _________ ___ _ _________�______ - -------------- Date------------------------------- ---- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Es--4-2M 9-50 w:1e39 Stockton, California