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a Z f APPLICATION FOR SANITATION PERMIT (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. 0 JOB"ADDRESS AND LOCATION---1[� ° yf� 6.� 1't'Ia� ! m _ /� ----- --- -- ---- - - Owner's Name-------- e2----�r- -'kli - - 4 - on Ph e_T'. a Address-- 6�--2�2- Contractor's Name--- _�_1�---= 1 _ ,-efQTl) 7S /J--------- - * Phone__ _ -_-_._---. - -- ---------------------------4-----'- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: Number of bedrooms J�t' Number of baths 0 Lot size-______ Water Supply: Public system ❑ Community system 0 Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jj� Hardpan ❑ 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___________ ____Distance from foundation___________________Material_______________ ---------------------------------- ❑ No. of compartments---•----------------------Capacity-----------------------Size-----------------------•--------Liquid depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material___-_________.___________- ❑ Size: Diameter--------------------------------------Depth--------------------------- ----------------------- Privy: Distance from nearest well________________________________________________Distance from nearest building____-----_______--_____ ----------------- ❑ Distance to nearest lot line Seepage Pit: Distance to nearest well----ZA1:1__"____Distanfe� from foundation__-_-_d-�__ �t�,n;e� to nearest lot line__-a_______- ® Number of pits----- -----------•--Lining mat �l— --------Size: Diamefier_--- f--------------.Depth--- Q------------------_>, Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line____-__________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------____-- _ Type of filter material_________________________Depth of filter material---__--____________--- Remodeling and/or repairing (describe):______- x�—l---------------- � f ---------------------------------------------------------- ------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andV11esnd regulations of the San Joaquin Local Health District. rt{Signed}____--1,,ing •! - iL?ll____-- _ ,_ _/7.S - -r—�'--------------------- (( y�li°i��pirt# iF Contractor) -- -------------- Plot lans, ize of lot, loc(aatiion f s stem in relation to wells buildin s et Sy:-- -------- : �" {Title} � d,e�P y buildings, c., must be filed with this application]. v FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- `' DATE_- l~12�' -� - --- ---------------------------- REVIEWEDBY -------J ------------------------------------------------------------------ DATE----------t--- o�'�� r l BUILDINGPERMIT ISSUED------------------------------------------------------------------------------�----------------.--- DATE - --Alterations ------------------------ and/or recommenda+ions--------------------------- --------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ---------------------------------- ------------------------------- -------------------------------------------------------------------------------------•--------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No._'1._Z,6--------- ISSUED,------�.'�_slQ-'.1-------------- Date FINAL INSPECTION BY:_________�1/j-_-V-_A� Date---------------- v g S--f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street S+ock+on, California ES-9-2M 9-50 W;f 639