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q 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 County Ordinance No.`549. JOB ADDRESS AND LOCATION_____ )' �l_._L'• Main and._101U_-s.__-Olive_9t - Owner_s Name---------------•---------Y----- ELV-----a------------------------------------------------------------------- ------------------11--------------- Phone------ ---------65------- Address-----•-------------------Rt•--_1,-- Box---103'---LindBn __ + . - -- - _.. - - -- i r Contractor's Name--------------------------�Q .'�a-------------- ----- -- -- - ------------------i--------------------- Phone o 5 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Courtl ❑ Motel ❑ Other!pq cabins Number of living units: JF] Number of bedrooms k] Number of baths I§ Lot size---1.37 ---x...194--------.___.________________ Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance-from nearest well__t' _'______.Distance from foundation.______ _____:JMaWill, "A 3 cell No. of compartments----------3--------------Capacity--- _?.0-0-- ------Siz 1'---XI.;-! ------- aqui ePt == Cesspool:' Distance�from,nearest well-----------------Distance from foundation------------------- material-__________-_-il__-____________-_-. ❑ Size: Diameter---- ----------------Depth---------------------------------------------------u Privy: R Distance from nearest well---`--------------------------------------------Distance from nearest building____._-___ r- __-_--__--_- Distance to nearest lot line------------------------------------------------ Seepae ge Pit: .Lt Distance to nearest well---- *!________Distance from foundation____.1Q_____3Stance to nearest lot line----- L_____ t [� Number of pits_____ _____________Lining material....brl,ek----Size: Diameter_._ �_..•__Q_*Av_Depth__________il____�sp____-____ Dispo'sal'Field: 4 Distance from nearest well---`-- '____Distance from foundation----1_�-_-_____-Distance 4o nearest lot line-----i_1_-_._.__ [ k Number f dines----1----------------------------Length of each line__----e.,f NVidth of trench-----_2�n-----_ ------------- Type of filterma'terialPQCk/4'��__Depth of filter material_l8p_-______ _.i` ` o ------------------new-- Stam- t--cab a 1�---an ---one--t_1_�-..'�_ert cal Remodeling and/or repairing (describe): _- �y -d-r-aia---anly---at---al�d--house------------- P I"' ► ------a t- _- �,-----------•----------------- --------------••-------•-•. ----------------------------------------------------------------------- == - -------------•------------------------------------------------ ----------------------- ----------------------------------------------------------------- --------------•----------------------- --•----------------- 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 Joaquin Local Health District. D-elta--------------------------------------------------------------------------------------------------------------- Owner and or Contractor (Signed) I [ / ) By:___----------------- 1'_erxy_---Waith -------------------------------------------------------- N Owner_ --M r..--------- Plo+ Ins, showing size of lot, location of system in relation to wells, buildings, etc.,f must beefi ied with +his a hcation ( P 9 Y g PP• )• FOR DEPARTMENT USE ONLY - -`- -------- --- -- ------------ - P r- 11 - APPLICATION ACCEPTED BY- -------- --------- �� DATE- .�I-- �--- •- REVIEWEDBY-------•---------------------------•--------------------------------------------------------------------------------- DATE----------------------------------- �------ BUILDINGPERMIT ISSUED.------------------------------------------------=------------------------------------------------ DATE S-----------------------------------I----------------------- . rt Alterations and/or recommendations___________________________ ___:-- r t 11 ` ---------------------------•- ------------------------------ ------------------- -----------------------------=- - ----- -- ---- -- `I` `' . ' ---�--------- ----------�-_'�a=--•-------•- ----------------------- It ------•'----------------- ----:----- --------��------------- --------------------------------------------4-------------------------------' -- ------------------`-•-----------------•"-•------------------- -kju PERMIT No______________ :__- ISSUED__ _--- _-- �� `1(Date) FINAL f NSPECTION BY ll------------- " ----- ---- --------------------------- - 1 1' y 1 S Date------------1.1-------------=-=----AI-`. .h----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT VV ~~ 130 South American Street S+ockton, California r ---