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n i APPLICATION FOR SANITATION PERMIT f 'I (Complete in Duplicate) j i Application is hereby made',to the San Joaquin Local Health District for a permit to construct and install the wor This application.is made.in compliance.with County Ordinance No. 549, k herein described. J063DDRESS AND LOCATIS —�� r ON---- Owner's Name------------------------ �----------- �� ------------ Phone--- -----��-�-�---- ----------------- _ - Address ; c �'� f1 ' ------ ------- ------E f 1-------- A-iL ---------- Contractor's Name----------------- _____-.__.-_ ?Apa x_ _ ' ' '77 - Phone--_, y� {--------- 1{ ' Installation will serve: ResidencertmentHouse ❑ Commercial ❑ Trailer Court � Number of livingunits: ❑ Motel ❑ Other ❑ � Number of bedrooms Number of baths (Z Lot size_________ O! Water Supply: Publicsystem Community system ❑ Private [1 Character of soil to a depth of 3feet: 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-ti __--Distance from foundation----- oundation____1Z Material___�`{�_._ ' No. of coin artments____-______ ' - - _"t -i, p - >� Capacity----if-------- Size_�_��_-f�� " �� - - - ----�------Liquid depth---`��__"------------ -Cesspool: ----- ----Cesspool: Distance from nearest well-----------------Distance from foundation-------------------,Lining material_-_______-__________-- ------ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well Distance to nearest lot line --------------------------------------Distance from nearest buildinjj� ____ ____ Seege Pit: Distance to nearest well__ M�y ---_-_Distant ftp foundation___ (i --_--_.Distance to nearest lot line_-_`�_"______ k Number of its_________ g -_-__ _Size: Diameter_j- .j p .�_________Linin materia �� Depth0----------- -- Disposal Field: Distance from nearest well_i_rjw„—______Distance from foundation___________________Distance to nearest lot line -------------- Depth _ 4 Number of lines_--____:__ _ -- w I Length of each line___".`.?--- --------------Width of trench_____ '� Type of f leer materiaL___ 'i / ii .. Depth of filter material_"______./f - Remodeling a d/o' rep 'ring (describe : -• ' -PfL10-�._ - .�------ _� i i1 ___"7w-_______ _ __ _ 1---------- �~r--�-------- --------------------- -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ! hereby certify chat ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules andr gulatio s of .the 'San Joaquin Local Health District. (Signed) - • J =---------------------------------------- Plat plans, s m size of lot, location (��'Contractor) RY •�+/ --------Title-- ( p } i �ss4c7cJ---------------------------- 9 ocatiort f system in relation to wells, buildings, etc., must be filed with this application). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-1----- --- - - ` - -- DATE------- -A - REVIEWED BY ---------------------------- - -- - - --------------------------------------------- ---------------- DATE BUILDING PERMIT ISSUED------------ - ------------`------- ---------- -- DATE tions: ------ ----` ------ ---- - ` " Alterations and/or recomm nda _ _ _ _ t - Ttlf ---------------- ----- -------------------- -------------------- ------------ PERMIT No./20-4$7_."$7 ISSUED----- _�__�Ij7�_-----(Date} FINAL INSPECTION BY:__ / - - -- ------- Date-----------------to- ------ '- 7-- -�7J - SAN JOAQUIN LOCAL HEALTH DISTRICT 1i 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California ' -4. — Al