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�O-APPLICATION FOR SANITATION PERMIT / O (Complete in Duplicate) Application is hereby made fo the San Joaquin Locafi Health District for a permit to construct and install the work herein described. This application is made in:complianc�e with Courty Ordinance No. 549. ��f ©r7- �. `L JOB ADDRESS AND,LOCATION F -------- Owner's Name - �------------------ - ----------------------------------------------- -- Phone •, ` . 3==---��--'�-- Address-,--------P._ =�_ Ld6la i - CAif'ornia ------. --------�------------------------------------------- Address-, ------------ = Phone s' -?.or { Contractor's-Name---------------=-----�-:Z.-�-------------------- ------------------ -------------- - - ------ -��-�--------- -- ----`'-=----------------- ---------- ----- Installation.will serve:�R'esidence 0.-Atartment-House ❑ Commercial ❑ Trailer Court ❑ i Motel ❑ Other F�'inei,y Number ofliving units: E] N mbar of bedrooms ❑ Number of baths ❑L Lot size______f_1_-_s�.C_x_e______--------_--------------------- Watery Supply Public system ❑ Community system ❑ Private ❑C y G Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan 1' 1 TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.Tank: �' Distance from nearest well------50_t____Distance from foundation_____-�9_1_____-__-Math rial____C�_Imen_ -�ti Ck - ------------- I&] No. of compartments-----------9-----------Capacity----8 0----------Size---4_'_ 5_'_x4:?------Liquid depth----- '_ 4----_ I Cess'ol: Distance from nearest well----------------- from foundation--------------------Lining material___________________ ❑ Size: Diameter-----------•---------------- --------Depth------------------------------------------------------ 1 r. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- ElDistance to nearest lot line____________________________________._________ i Seepage Pit: - Distance to nearest well----_75!----------Distance from foundation_____8_-------'_.Distance fo nearest lot line_______ {___ ® f3pecial Number of pits--_--------I-_------Lining material-----------------------Size: Diameter---:- ------Depth-------2aT-_-__-__-____-+� r Disposal_Field: Distance from..nearest well______--___-___-D.istanded omtjoundat.ion____________________Distance.to nearest.of line_______- --_-j .. ❑ _ Number of lines-----------------------------------Length of each liner----------------------------Width of trench r Type of filter material-------------------------Depth of filter material___________.__--_-_- Remodeling and/or repairing (describe) _.a_tj„Oi'i, of-__Qme ____Sef7-tj:C—�,ci111{ Znd_ r x___salici---lines---end__in ling---off ---(.?-)`--Y 'tT�a - drain a send and filli,n4 ------- -------- --------- s_eal;_tia1-----�vih---22--=inch_.. i ---rCk___a3._7�---- h ---'r�a�t--- o---say �"=""heavy_anc3---loded ,,,� r --t-rucka---pa-s-s--over----tllLe----ink -_- rid--Qv e vertical expec- _a y I hereby-certify that! 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. # #'-••w•--- I Si ned f { 9 ) Delta ------- --------------------------------------- ----- (Owner and/or Contractor) e a d/o _ gY� PAX' 'y '_ '_ ¢a----- -------------------------------------- a Owner r. ------------------ ----- {Title)----- --------- - (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY----- -- -- -- -____1_1--------------------------- DATE----- - ------ -- ------- ----------------- ----- -- REVIEWED BY------------------------------------- --------- _ BATE- -------- ---------------------------------------------=------------------------ a BUILDING PERMIT ISSUt<D. -------------------------------------- -------------- DATE---------- Alterations and/or recommendations--------------------------- ---------- ----------------------- ------------- } ----------- ------- ------------------------------------------------------------------ -----------------------------------------------------------•---------------------------------------------------------------------------------------------------------------- --- ! o ---- ISSUED - �. - ----- --------------------------------------------------- .--------------- =- -------------------------------------- PERMIT No t_____ ISSUED___________ ___ _ Sj---(Date) FINAL INSPECTION BY:__!__.________-_ Date----------------- f ,l --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street IX ES--4--2M 0 W-1639 Stockton, California �w. 4-5