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r APPLICATION FOR SANITATION4ERMIT- (Complete in Duplicate) Application•'is hereby made to the San Joaquin Local Health District for a`parmyt.to construct and install the work he'rein This application is made in 'compliance with:County.Orclinance','No. 549: # JOB ADDRESS AND LOCATION---.------ - =---------- ---- w ------------------------=--- ----------------------------- -------------- �-� e ' Owner's Name---------- e-s---�fOrl;h------------------ ------------------------- - -------------------------------- --------?----` ----------------------------------- -k:. Phone +i ' p Address - -------------------------- -------------------------------------- f ---- # Installation will serve: Dei 'Apartment '4; - Phone '�-3r3� p nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑~ Other43 ❑ �, 'Number of livingunits: Number of bedrooms f .baths Lot�size-_____5rC__x-___} ❑ [� Number o m 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 ❑ �f 1 TYPE OF.INSTALLATION AND SPECIFICATIONS:. ., sE (No sepific'tank or cesspool permitted if public sewer is available`within 200'feef.) Septic Tank: Distance from nearest well `r0_____Distance-from foundation----aSf____-..__.Material--------- U__________________-- ^�"t"";��r_'S�#. ❑+1],`210 "� r ,.�• �o �tompar�;m--, e �n t . 2'- -Capac-it--y--_-a---p-p--_-�--&--0Q_Size _ 57 _?.f-----/ ------- ----Liquid d epth-------- Cess ool: Distance from neaestwell-_-____-------•--Dis#ante rom;foundation___ - -------------Lining material---- -----------�--------_-�- Size: Diameter-- , -De th------------------------------------ ------------------ Privy: ------------- - --- -- ----= Privy: Distance from nearest well______________________________________________Distance from nearest building _ Distance to n06ret lot-,line------ ----------------- eeP ge Pt: Distance to nea"restwell----------------------Distance from foundation--------------------Distance to nearest lot line________ ___-.-_-_l_-- __Number of.pits---_ ^-----------Lining material-----------------------Size: Diameter------ -----------Depth---------------------------- -- -- ouDisposal Field: Distance from' nearest well ---`ro-,___.Distance from fnda+ion-Y _____.__.Distance �. to nearest lot line_____:_..._. Ek ', ' Number of lines._`___1------'-------------.------Length of each line___]O!�!____ __________Width of trench_ Type of filter•material,__x'�Cl�---------Depth-of filter material'________________ 1 Remodeling and/or repairing [describe] ------2 aw--__inT a. allat_jan________________ ----------------------- ------------------------ ---------- ------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and.fhat the work.will be done in accordance with San Joaquin County j ordinances, State laws, and rules and regulations of the San Joaquin*Local Health District. b (Signed)-------D-elt.a --6-A-t-J_O---Tan.k 3 - --- -- ----- ------------- (Owner and/or Contractor) By:---------------Perry---td_art 1aa? --- ------ '------- -- ----------------------=---(Title)------Q�r2�r_-�'�'-�------------------- - ----'- (Plot plans, showing size of lot, location'o syste in anon to Is .buildings, etc., must be filed with this application). . F.OR DEPARTMENT USE ONLY 1` y�� APPLICATION ACCEPTED BY --------------- - ------ -_ DATE--------- ----------- -3 - REVIEWEDBY - --,------------------------------------------------� �----- --- --------------------------- DATE--------��-------' BUILDING PERMIT ISSUED--------------------------------------------------------------'---------.------ ----------------- ---- DATE----------------------- - Alterations and/or`recommendations:------------_------- ----._- , ------------------------= =------------------- ----------------------------- ----=---------------------------------------- ------------------------------------------------------------------------` -- -'------------------------ ------ •- 9 ---------------- ----- - --------------- ------------------------------------ ------------------------------------------------- PERMIT No..- •--------------- ISSUED_------- _ ,5-__----------_ ]Date FINAL I'NSPEC'T-ION T k I ECTION BY: ' " -------------------- Date--_ ------- ------- LIV SAN JOAQUIN LOCAL HEALTH DISTRICT R 130 South American Street . a� Stockton. California k ES- 9z-2M 9-50 W-1639 4�