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f APPLICATION FOR SANITATION PERMIT 9a7 IAsl� , (Complete in Duplicate) 7//- 9�.�9 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 p�County Ordinance No. 549. /-0-7j' 1�'V6/ice.e S' -r JOB ADDRESS AND LOCATION------------- ___ ---------- - r -- -------------------------------------------------- --------------------------------------------------------------------- Owner's Name--------------`�f S - V=x-------------------�----- egy�pp••----------------------------------------------------------------------- Phone------------------------------------- Address ------------------- - } - ------------ Address--------------------------------------------------------- `�r Zo �-^1'1 x1e A-a f r Nlis�r 9D O/1 ic's i' --------------------------------------------------------------------- Contractor's Name------------------------- ----- Phone-------------------- i Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '[A Number of bedrooms .9� Number of baths 0 Lot size__ ......___________________________ Wafer Supply: Public system ❑ Community system ❑ Private 2 x _ Character of soil to a depth of 3 feeti: Sand E] Gravel E] Sandy Loam ElClay Loam ❑ Clay E] Adobe z Hardpan L] TYPE OF INSTALLATION AND SPECMICATIONS: - (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic Tank: Distance from nearest well---�0------.Distance fro� foundation--------!------_.ldlateria ------------------------ �✓ - [J� No. of compartments______________�'_-____:Capacity__�EP�__ S ---Liquid depth______"____- r Cesspool: Distance from nearest well_________________Distance from.,foundation-.-_____-_______._.Lining material___________--______________ ❑ Size: Diameter----i--------------------------------Depth------------- ------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__---------______________________________. ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot line__.____-_--___.-- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter____________ ----------.Depth---------------------------- _(— -- - ---- ------ -� T.. •.Dispos Field: Distance from nearest well___ b-�_-Distance from foundation____/''..........Distance.to nearest lot line----- _______ Number of #fines _____ l__ ___G_ __li�ength of each line_________?. --___ _____-Width of trench________c _______________ i Type of filter material ,� ,�-Depth of filter material_...__Ae-__________ � - t Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------•---------------------------------' s ------------------------------------------------------- -----------------------------------------------=---------------------------------•------------------------------------------------------------------ a ---------------------------------- -�_=------ l:Cji------ 7`. ------------------------------------------------------------------------------------------------------------ i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County d ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ----t-L ------------------{Owner and/or Contractor) By:-�----------------------------------- - ----- � - ------)Ti+le)---------------------------------------------------------------- Plot plans, showin size of lot, loca+ion o s st in relation o s, uildin s, a us+ be filed with this a hcation P g. Y 9 PP )• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE} ^ DATE -------------------------- - REVIEWEDBY--------------------------------------------------"'---------7-------------------------- `--- ------ DATE------- - 1` - . r,a� BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------•-----------------------------•------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- t ------ PERMIT ISSUED__ '�___ _s�-___.. ---(pate) FINAL INSPECTION BY:____ a Date-------------- ----�--- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street f Stockton, California ES--9-2M 9-50 W=1639