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---------------------- r APPLICATION FOR SANITATION PERMIT �- [Complete in Duplicate] a is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ApplicationY This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------26 '+ Phone----- -.-'16-C-------------- Owner's Name---•------ d-LM110-11---21-1-- -U_, - -------------- Address 26-0--�t'!�y-__AV-- r--Stk_'_n-•-*--4�' ].f - Phone_ 3-3,9,5-5- ------- ---------- Contractors Name---------------Dei. _&------------------------------- -- Motel ❑ Other ❑ ,. Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence] p Number of living units: -MR. Number of bedrooms []RNumber of baths 0, Lot size-------12-3X.---2)5A-------- ----------------------- Y system stem ❑ Private [Z private Water Supply: Public system ® Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe [ Hardpan ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Cat Capacance ity_ foundation ze--___.__________Materlal-Liquid depth--------------------------- 0 ____--____ ----------- ❑ No. of compartments______________________ p f Linin material______ Cesspool: Distance from nearest well___ 0t------Distance from foundation____50---------- 2XUt Size: Diameter -Depth--- ---------------------------------------7:------ ---------------- _ Distance from nearest building_______________ ---------- Privy: Distance from nearest well_______________________ __ -------------------- 4 ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well-_______________-----Distance from foundation------------------ Number to' nearest lot line______-__.___-___ Linin material-----------------------Size: Diameter----------------------Depth--------------------:------------ � Number of pits____________________ g Disposal Field: Distance from nearest well-------------------------Distance _Dength ofrom each I�e foundation----_-_-__------_-Distance tftfrench est lot ine----------------- Disposal --------- - AXiS�' i191rNumber of lines_______________ •Type of filter material-------------------------Depth of filter materia--------------------- re az -id--- _�---pur=mtt----------•----------- Remodeling and/or repairing (describe):--------------- p - ----- --- __---------- ------------------------------------------------------ a_ted--#;Q---rep; ,- r--Q3d---e-e S�ptry i f _ ---------------------- ------------------------------------------------------------------------------------------------------------------ -------------------------------------------------- --------------- -- I hereby certify that•I have pee-a-redulthis tions olf the San Johat the in e cal Heawill 1 be done ctn accordance with San Joaquin oun ty ces, State laws, and rules a 9 ordinances, _ _---[Owner and/or Contractor) (Signed) �:t_a.-Sent�_i�__T_ank__Ssr�r3 > - ®_."� -------------------- . --- * ---------(Title)----C;SFi?e '� "l--•--------- 1 BY'-------••----------•---2-err-y-"_ar_tha.xa ::o- -- [Plot plans, showing size of lot, location of sys#em in relati n to'w11 e Is, buildings, etc., must be filed with this application). k FOR DEPARTMENT USE ONLY ------------------ -- - --- DATE----- ----- - APPLICATION ACCEPTED BY--------------- ------------------------ --------------- -REVIEWED BY----------•---------------------------------------------------------- -------------- ---------------• DAT ---.:------- -- BUILDING PERMIT ISSUED-------------a--;----------------___-------------------------------- ------- --- -- --------------------------- - --------------------------__-'_-1-----._)7,------------ -- : ------------------------ DATE_------ ---------------- -------------=-------------------- --------------- --------------------------------- Alterations and/or recommendations___ _________________ __------------------- r:=--• ------------- ----- -------------------- --------------------------------—----------------------- - -� �3 �.i�/------- Date FINAL WSPECTION BY--------- ---------A------------------------- ------------- PERMIT No------- ------------- ISSUED----- ------ �' } `� 4� Date--------------------------------- ate--------------------------------- ~----�----------------------=----• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street { Stockton, California ES--9-2M 9-50 W-1634