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;APPLICATION FOR SANITATION PERMIT N (Complete in Duplicate) 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. 549. % -t I r r _, i JOB ADDRESS AND LOCATION----- ------------ 1�yi� ---------------------------------------------------------------------------------------------- --------------- --� -- --------- --------------------------- -------------- Phon --------7 7 "�--------- Owner's -------- Owners Name----------------- ------ -------------- ----------- - Address------------------------266 2a;------ ------------------------------------------------ ------------------------------------------------------------ St'1rt t_ ----------- '.. Phone Contractor's Name--------------- �i ----- ----- -- Installation will serve: Residence ;& Apartment House ❑ Commercial ❑ Trailer Court .❑ Motel ❑ Other ❑ Number of living units: El Number of bedrooms ED Number of baths ❑ Lot size-------------/1_15--_-___x__lp_Q------------------ Water Supply: Public system ❑ Community system ❑ Private f Character of soil to a depth of 3 feet: Sand,® Gravel.0 Sandy.Loam ❑rytiClay Loai ® Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm'tted if public sewer is available within 200 feet.) ' 00 terial--------x _d_ aFj---------------- Septic Tank: Distance from nearestwell_____..-O _-'- Distance from foundation. I� - Ma e `7 ents____________ _ Capacity-' q� Size -----Liquid depth------- No. of compartm Cesspool: Distance from nearest well________________ Distance from foundation-----,--------------Lining material----------------------- -- ---------- ❑ Size: Diameter-=-----------------------------------Depth----------�---------------------------------------- A-7DistanGe from nearest building ----------- Privy: Qistance from nearest well------�-------------- ------------ ------------- --------- ----------------- ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well___-________________-Distance from foundation:_________-'_-____^Distance to nearest lot line_________________ t ❑ Number of pits-=---------- ------Lining material. �S e: DiameterDepth t 10 1 Disposal Field: Distance from nearest well.... -----.Distance from foundation_;______ ______Distance to nearest lot line______ 0_____ Number of lines`_--_------ .--------------Length of each line---S S_'-zS`_ ___-Width of #rich_______- U.�----------------- Type of filter materia4--_`tvCGLk---------Depth of filter mateial___----! I! Remodeling and/or repairing (describe)_________________________ VZ-5 7�1 ----=----- --- -L-------------••-----------------------• i f-------- ------------------------------------------- ----------------------------------------------------------------------------------------------- ----- ------------------------------------------=------------------------------------ --------------------------------------------------- - I hereby certify that I have prepared 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 Health District. (Signed)-------- �, Lt' - ------------------------------------- By: - ------- 1'`= . ' (Owner and/or Contractor) -- --•-• -- - - in relation -------- ------- -------------------(Title)------------•---------------- ------fi plans, showing size of lot, location of system to wells, buildings, etc., must be filed with this application). a i FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY ----------------------------- -------------------- DATE II T -------------- REVIEWED BY--------------------------- -- - ------------------------------ -------------------------------- DAT F `�! � }Std -- --------------- - -- BUILDING PERMIT ISSUED-------------------------------------------------------------- Alterations DATE Alterations and/or recommendations__________________________ __ ----- --------------------•------`-'- ----------------•----------------------------------------------------- ------------------------------------ ------------------ - ----------------------------------------------------------- ------------------------------------------------------------ -------------------------------------- -------------------------- -------------- � _gip PERMIT No---- ---------- ISSUEQ---- -(-------( - 7 (Date) FINAL INSPECTION BY:-- SANDat JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 4