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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - r3 0--�,� � 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 madejn.compliance with County Ordinance No. 549. B ADDRESS AND LOCATION_- -�---�3 ._._fix.----�$2-�---Sf�k'n.,---�al1f ._----------- rte. P .. Owner's Name---�1 _=•__ -- [ 'a . 1�� -- ----Gin-- --------- Phone_2--n-3'62'>-__$_t-kI_n � Address---- • II= .fix 282_s ►�t�k._x7�_•_�----Calif... &---108-- Contractor's Name----D-elt*L__Z.ept_j0 T"__r 2Y'y e %—= ----------------------- ---------•---------- Phone---- Installation will serve: Residence ❑ Apartment House ❑ Commercial [3 Trailer Court ❑ Motel ❑ Other [NO J1 Sta. 'r -Number of living units: ® Number of bedrooms [I Number of baths [� Lot size___________________________________.___ Water Supply: Public system ❑ Community system ❑ Private D: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam [] Clay ❑ Adobe ❑ Hardpan E] CJ 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_/001_____Distance from foundation_____ ^•� '� El 1 � Material s-e' _Xia-�-�.T3 3 t jnVo. of compartments Ca acit t3= '�°_;_- Size,= ----- Liquid depth # Y yrs F �-' �✓. �o o- 9 ; �`elp Cessporf Distance, rom neares well________________Distance from�founciahion-----___________ __.Lining ma al-------------------------- f . . ❑ Size: Diameter--------------------------------------Depth------------------- Privy: Distance from nearest welh_.__------------------------_-------------------Distance from nearest building ❑ Distance to nearest lot line___ _ Seepage Pit: Distance to nearest well!____________________Distance from foundation---------:---------.Distance to nearest lot line_._______________ ❑ Number of pits __H_.�' Lining material-----•-----------------Size: Diameter Depth --- 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):_--t_e�lk-_js----tQO_--ZM �g �_. lows---- bak_. ah s_�tat� . --at---h�__we ' t ----------------------------------•-- ------•--- ------ - - ------- ----------- - M 41 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed)-------Ilelt __5 � � __ Erik..►��x'Y �e-------------------------- ----------------(Owner and/or Contractor By:---------1a'ry_._Xa th=-------------------- --- -- ------ ----- -- -- - ------ -- ------ Tale---gq�mgl 71 gr (Plot plans, showing size of Iot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY------------W -� DATE J4! -`f`d REVIEWED BY --------------------------------- - --- ---------------------------------------------------------- DATE------------------------------I---------------------------- BUILDING PERMIT ISSUED DAT ' - ll�____ :- sQ.?. -p- }-! A��a ----------------------------------------------------------- f.----giYAlter f ns and/or recommendations:__.- --------6- A_G- -------------- --------------- ------------------------•------------------------------------- ------------------ PERMIT No._ a-_��__..------ ISSUED----LIL_-_ --- ---------------(Date) FINAL INSPECTION BY:________________----_- -------------------------------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES--9-2M 9-50 W-1639 Stockton, California i