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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. E This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION X215 �' �i&1 ._� r _ �Y1 s + lf..--------------------------• -- ------------------- Owner's Name-------`-�'ir-'• a:�d---Tarr-a-•-..1 Mr -s----4215E Main------------------- Phone----------*i[1723 --------- Address............. 4215--Z` •---M- jn... Qwl_-Gaf'e---------------- A - II _ Contractor's Name-•----n,1)e'_3.ta---Sapt.lQ...Tank__5_e=_ijae-------------------------------------------------------------- Phone------3---3-9-95------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ® Trailer Court ❑ Motel ❑ Other II - _ Number of living'units: ❑ Number of bedrooms ❑ Number of baths ® Lot size__-------12-'___x---16-9-------_!___________________ Water Supply: Public system ❑ Community system ❑ Private Character of,soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ NIS TYPE OF INSTALLATION-.AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) P P P P .. , , -- Septic Tank: Distance from nearest well_________________Distance from foundation--------------------- ---------------------------------------�_. Cpexis'ting No: of compartments...------- •------------ Capacity-----------------------Size-----=------....................Liquid depth II----------=-------- Ir Cesspool: Distance from nearest well Distance from foundation___________________ Lining material______--.._____-------_-_--- ❑ F Size: Diameter--------------j---------•=------------De th-------------- - ------ - -------------------- Privy: Distance from nearest well_ ______2______________________________________ Distance from nearest building__________________T----- - } ' t F Distance to nearest lot line.......... a +_ Seepage Pit: Distance to nearest well_____________:_______Distance from foundation________________ tanee to nearesf laf lin' �J�,e--------------` . ® Number,,of pts,_.---1_____--`-;Lining material---br-I.Ck-----Size:Diameter_:_____----_^-��Depth---------*?_-------m"---� _s K. ,. .,,. , '.s . r - Disposal Field: Distance from nearest well_________________-Distance from foundationo_y__;_______:Distance to nearest lot life-=- ii ' ® Number of lines----- -----�.-----------------Length of each line--------__-------------_-----.Width of french----app--!__.22 ______ Type of filter material_`_--SO.4k--------Depth of filter.material___ $_____________ Remodeling and/or repairing.(describe):___-:__Y'C� 1&fir_ 31g__________________________________. ------------------------------•------------------------------ = _ ---------=-- --- ----- _ f►--6-------'--------'L-1'-`, - 4110 =rC _ r r/r� wr9 D ;?T G_ 1 ----------- - -- /O ,e y f --- � t Nc l� _�i+1-f�f�,F- r�'_E_ cJ� `I---�-- 'fv_ T ------`--1,-r f I hereby certify that I have prepared this application and that the w6rk will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 14" .r.4r1'/3 d7' G A Fm..-r. oA/ c.aa�r (Signed) . ----------------��7#�..S� �iG---Tank_�ervi��------- -•------ --------------------------------------------- - , {Owner and/orContractor) ; --------Derr_Y-Jdar-th,9n---•----------------------------------- - ------`--------------------(Title)--- --S7wner__=I++I�r -------------------- (Plot plans, showing size of lot, location of system in relation to wells,.buildings, etc., must be fled with this application)If FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDaY = DATE--------- 1 !:` = � 1�-------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------------- DATE--------------------------=-----------1----------------•-- BUILDINGPERMIT ISSUED---------- ------------------------------------------------------------------------------------- DATE----------------------------------------1--------------------- Alterations and/or recommendations----------------------------------------------------------------------------------------------•------------•----_- --- ---------------II-------------------- -------------------------------------------------------------•------------------------------------------------------;-----•--------------•------------------------=-•---------------------------------,-- 1�----..---------..... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------•-------------------------------------- --------------------------------------------------------------------------------- ----------------------------------------------- �1 PERMIT N..__. 'f� -------- ISSUED_.. ^.-�L-- --5-- -------------(Date) FINAL INSPECTION BY:-------------__ _-____V- , ---_j--- ---------------- Date------------------------------------------------- — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639