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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4d-(00----?7J 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 County Ordinance No. 549. J08 ADDRESS AND LOCATION--------------------- --------------- 1 ✓"'" - ` f '- , 1 a Owner's Name----- '------ Phone-- Address------- hone Address = = -------------------------------•--•------------------------ ----------------------------- joContractor's Name _AJA--- --1/t..'- ------�- Gs,... -------------------• ------------------------------------- Installation will serve: Residence M Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 'j] Number of bedrooms Number of baths Lot Water Supply: Public system Tg Community sysfem ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)4, Hardpan x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wella''r''Ge_Distance from foun' ation------L.n__._.Materia7l----- ------------------- No. _________________ No. of compartments-_--------2-----______Ca Capacity q®°�s Size _�r `._ G.�� _t�Li uid de tn__�'_ ---____________ P Y - ------ ---- q p Cesspool: Distance from nearest well-_______________Distance from foundation_______________.Lining material-------------------------------------- ElSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well:-------------------------------------_----------Distance from nearest building------------------------------------------ El Distance to nearest lot line________________________________________________ f Seepage Pit: Distance to nearest well% ^^K-: Distance from foundation------?T- _.Distance to nearest lot line____4 ------ Number of pits__________ _________Lining materia]A-�___ -,_Size: Diameter____�F------------Depth-------L ----------------- Disposal .rt� Distance from nearest-well "__.Distance from foundation_=__�_7--___.__Distance to-nearest lot line----'�7-------- Number of lines___________ __________ Length of each line--------7 '-- --° Width of trench---�-Y-'-------------------- Fie Type of filter material_/ ____Depth offiltermateeial____— - j (� Remodeling and/or repairing (describe):-------------------------------- -------- - i . ------------------------------------------•------------------------------------ - j i _----------________________________________________________________________________________•_________________-___-_._-_______-__________-_____------------- _____________1_______________-_--__-__„_______-_____________________________________________-______-_______--___________________-___--_--_.___________________________________________-- ------------------------------------- ! hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules and' regulations of the San Joaquin Local Health District, f .. (Signed) r - = ----(Owner and/or Contractor) f ( � ) y` -- ----------------------- $Y� ------------ - �l = = Tale (Plot plans, showing size of lot, location of system iT o wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY - z APPLICATION ACCEPTED BY ------------ DATE--------/----.. � S71 REVIEWED BY - ----------------=- _- g-----i_ -" 4 I -------------. DATE-------- l4� - `- ----- BUILDING PERMIT ISSUED-------------------- -E-� = '; -----------.,, DAT Alterations and/or recommendations:---------------------------------------------------------------------1= 4 4 -----------=-----------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------- -----------------------------------------------------------------------•-.-..------------------------------------------------------------ ------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMI' iT No----------A----------- ISSUED------ �� a'� ---------------(Date) FINAL INSPECTION BY:. -%---- c ------- Date-------------•14-11 ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639