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,�'�-„'.�•—'..' �.,. ...:ted. _.- � - Y;.. SANITATION,PERMIT APPLICATION FO SANT [Complete in Duplicate] Application is hereby made,- o the San Joaquin Local Health District for a permit fio construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. } ------ - ---- --- - ” JOB ADDRESS AND LOCATION--__ -:211' 5 �=t ��' _ i ----- - - - - Phone . . 1 k Owners Name .. --------- ----- ---- --- --- -E.R__ i3 Cn �' --- -- -- --- Address. 2 .2 _ Phone-_ - �� Contrinstallation wdl serve: Residence ® Apartment House Commerual+ ailer Court ❑ Motel ❑ Other ❑ " actors Name-__._______D„-1ta,---- " - ----------- - - �,., . - ' of baths [�• Lot•size----��--0 ,,27---------_------------ -------- Number of living units: ENumber of bedrooms Number Water Supply: Public system ❑ Community system ❑ Private Lo Clay ElAdobe (� Hardpan;❑ 'Character of soil to a depth of 3 feet: Sand F1 Gravel [I Sandy Loam❑-,. Clay L ❑ �. TYPE OF INSTALLATION AND SPECIFICATIONS: ' [^ p p (within 200 feet) [No septic tank or cesspool ermined if public sewer �s available P �-�= Material G421� _-Q '2,C " - Septic Tank: Distance from nearest well fl _.__Distance from oun anon_--- 5'-x x4l Li uid depth 4t _t No. of compartments__---- --2--- --- ---Capacity _ _---- -- Size-- _--- ------ - G p Linin "material-------------------------------------- Cesspool: __ ._._ - ---- ------ Cesspool: Distance from nearest we}}_________________Distance from foundation-------------------- 9 ---� "--- ❑ Size: Diameter-------------------------------------Depth-----------------------r-------------------I------ -- Distance from nearest well------- ----------------------- ________ - ________________'Distance from nearest building ---------- ' Privy:� - - .;El r Distance to nearest lot line------------------------------------':.------ - *,„ Seepage Pit: Distance to nearest well:________________.Distanee from foundation--------------------Distance to nearest lot ine_,_.__._____-,_._ Linin material_ Size Diameter---- ---- -- Depth--------------------------------- Number _ --- --- •---- - --- - '�❑ Number of pits-------------= --- - 9 t D.istance_fcom foundation = .Distance to-nearest-lot s- —� _ sp sal Field; Distance#rominearest,well.___-2 - Vdidth of trench__ __ ___ ___-------------------- D1 Number of lines_-__1_____ _________ _ ___ _Length of each-line:__ ___ __ _ «- Type of filter material---Y'i!cl!---------Depth of filter material- ___�. �� --- ------------- irin (describe): ��-E-�-� -------- ------ ---•--- - � Remodeling and/curt ( ) - - - [; �} _---- ------------- ------- - - - --------------------------------- --------- ------------ ---------- ------ ------------------------ ---- .,- I here6 certif that I ve prep'red 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 He Ith District. .-- l ------------ ------------ --------- r .. .[Owner and/or Contractor) (Signed) m f s stem m vela on o wells, uildings, ) x ---------- Pery___ �1araax1__ BY: etc., must be filed with this application). {plot plans, showing size of lot,, location o y FOR DEPARTMENT USE ONLY ---------- ----------------------- APPLICATION ACCEPTED BY--- Z - - DATE_. - ------ - REVIEWED BY------------------------------- ------------------------ DATE, BUILDING PERMIT ISSUED---------------------------------------------------- - DATE t - Alterations and/or recommendations:_-.--------"---------------------" - " - - - L _________________________________ ,& , _____________!._. __. r I ! __ _ ___ --------------_ _ _ ___ _____________ �__ --------- --------------- _t._! _ -_._ -- ___ _______ _____ , _ _____- . __ __ - ... ------------------- ----- _--____-.--- __ -------- Alterations - - - __ __ - _. -_-- --I._-- - ..... - - -------- - - - __ __._•____.-_-._`___________________________ __ - i -`--"---------------_----- [ _ r - - ------ �} ISSUED Date FINAL INSPECTION BY: -"-- - ---------------------•---------- PERMIT No. - "--- ED--------------- - ----- -/*Al (Date) - -- �. ------ -----��/_--�1-�-- �-- -------------------------- SAN --- ----------- ------------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1634 --