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APPLICATION FOR SANITATION PERMIT II (Complete in Duplicate) i 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. 50. JOB ADDRESS AND LOCATION--p---�----- f5� .3 ------ 1c-- ----------------------------------------------------------------------- Owner's Name-----------pwia-------W�y ... .-lsi- 1//-` ----- ---------- Phone------------------- Address--------------6'331-----�--- l___/_1_ •mac-------------------- ------------------------------------- •-•--------- ---------------------- Contractor's Name----------------------------------------------------------------------------------- -----------------••-- ------ Phone------------------------------------ Installation ---------------------------------Installation will serve: Residence K Apartment House ❑ Commercial-❑—TTailer Cour•#--H-..,Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms a] Number a,6-batbs,.[].,_;•Lot size_-____-I 6_d___________________________ Water Supply: Public system ❑ Community system ❑ Private!x Character of soil to a depth of 3 feet:`fSand ❑ Gravel ❑ Sandy Loa ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan XW TYPE OF INSTALLATION AND SPECIFICATIONS: 4 W (14o P P P P h-.+ -25-------.Material-------R!st cl----W--@ y Ivo se tic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest welL__s0_____Distance fr fo nda+ion-__-_ Liciuid, _ - } No. of compartments-----------". __________Capacity_' Gl"S�_�_ Sixe____- � _ QT�-T .. Distance from nearest well_________________Distance from uncia+ion__ _____---_ materialj------------------------------------ Cesspool- r4 ❑ Size: Diameter---------------------------------------Depth--------- 01� 9 Privy- Distance from nearest well----------------------------------------------Distance from nearest building___ -. 1 - . Distance to nearest lot line___________________ ________________________ r � Seepage Pit: Distance to nearest well----------------------Distance,fe'om foundation--------------------Distance to tin Barest lot line_______________-_ ❑ Number of pits Lining material~= Si Diameter------------------------bepth-------------------------------- f -------------------------- i Disposa Field: Distance from neares}well____rp._ .-Distance,from fund tion Distanceio'nearest lot ine----------------- q _____ ____ -•- Number of lines___ _ n' th of ac ire a�fr_0 - `� i . -- g , r, r. W,rdth of trench __ Type of filter mat ial------------------------ pth of filter matdrial-----Zrf_^__ J I Remodeling and/or repairing (describe):_____ ___ ----------------------------------------------------------•-------•--------------------------- ------------ ----------------------------•-------------------------------.--•------------------------- r t --------- --- -----------S-------------- '; -------------------I--------------------------------------- hereby certify that I have prepared this application and that the work will be done-�in Acordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. 1 I (Signed)----------- "'� ' a �'`` � ------- ---- --= _• I {Owner and/or Contractor) Oy:-------------------------•--------------------------------------------------------------------;I-------------•-- -�------- ---(Title)------------ �--------------•--------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- _ DATE____ -_________________ REVIEWED BY------------------------------ - n DATE--: -------- __Z------------------------- BUILDING PERMIT ISSUED-------- 1 -------�V � r ------------ 2:11 DATE 14 z U1� Alterations and/or recommendations------------------------ -------------------------------------------------------------- --------•------------------------------- ------------------•---------------------------------------------------- - ---- ----- ------------------------- -- PERMIT No. 's ISSUED--- ------------------------------(Date) FINAL INSPECTION BY:------------- ------- 1 ----------------- Date----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639 '