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3q APPLICATION FOR SANITATION PERMIT (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 Coun t y Ordinance No, 549. C. JOB ADDRESS AND LOCATION , L � .A of o-i�{1-e-He------------------------------------------------------------------------------ q Owner's Name-----�h - � ---------------------------------------------------,-------------------------------------------------- Phone----•------------------------------- Address--------- 'Q Contractor's Name-----------6?--W-Aj-.-A2k---"---------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial [-❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 2 Number of baths F❑ Lot size---------/_Qc---X_!_ao________________-__ Water Supply: Public system ❑ Community system ❑ Private K Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe o Hardpan ❑W, 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---- `-----Distance from foundation-------- ....__.Material___----- [� No. of compartments-------- --------------Capacity-----ftp_ ---------Size---/- -X depth-------Y--------------- n Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________--_______._____----_________ y ❑ Size: Diameter-------------------------------------Depth--------•------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------- El Distance to nearest lot line_______________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line______________I ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--------.--------------.----__1 � Disposal Field: Distance from nearest wefl_____�i�_-___.Distance from foundation_____fl�------- Distance to nearest lot line_--_�D-.__ Number of lines__•_________ + I Length of each line---------- - ii------Width of trench----------.�-----------------'Type of filter material__�_VA-k_ -- Depth of filter material_-_____1 --------- Remodeling anq{/or repairing (describe): 1)-R' '_'------- ---... . -------- -4--------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couny ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- - �_ •V` ''� A-------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------- --------- plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------W-------- V ------------------------------------------- DATE--------- REVIEWEDBY------------- -------- ----------------------------------------------------------------------- - -------------------------- DATE---------------- ---------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------- -- Alterati d/or recommendations--------------------------------------- ---------------------------- --n-n-7-7 ------------------ --------------11-------W*or------ Zk+� -------�M------bl i---------__----- ----•----------- --------- -- - ------------- l4�tt1C l4►_d --------------- -------------- --------- -------- �E------`�.. - ---- - ---- -------------- - ------------------------ -- ------------------- S-- --- ------ ------- ------------- ------- -------- --�•- •-!--4 •-�=-•.------------ ----- ---------------------------------------------•-----------------T/,- -b----- ------------------ ------------------------------ S ' ' ' - PERMIT No._3__!__�_________ ISSUED__:_______ _ J ,z ___.__..__ Date FINAL INSPEC - ' / I f =----------- - ----- -ice ----------------•- Date-------------------------- --------;�_- --� -----��---=---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street- ES-9-2M 4-50 W=1639 ;= Stockton, California ' 7