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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 twith County Ordinance No. 549. ; o �- a -S ---------- '� �� 44_.3-------- -9 JOB ADDRESS AND LOCATION------'�y Phone------------ Owner's -----—----- - ��---_�r .�•j �� -`_// ----_----------------------------- Owner s Name---------- --- - - -- ----------- --- -- ---- ----------------- --- 4C_R � __Pr ------ ------------ ��2 rte- i Address__.---•'��-_�-'��'--------• --- ---- '7 �-�' ----------------- . --- Phone-_V-:4-46-01- --- Contractor's Name- .-- �--' Trailer curt ❑ Motel ❑ Other ❑ Apartment House ❑ Comm eresal (� TIG _ Installation will serve: Residence ❑ Ap Number of baths �' Lafi size-____ J__ __- -- / ©" """"" Number of living units: ❑ Number of bedrooms ❑ Water Supply: Public system QK Community system ❑ .Private ❑ : Hardpan PP Y Clay Loam ❑ Clay ❑ Adobe p ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y I TYPE OF INSTALLATION AND SPECIFICATIONS: / f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) le p ,{1 arest weld_0_ ------ Distance from foundation___1 ____---M terial_(dl1c---�+-'- p Distance from ne Capacity_ _ �r Size' ��-'it- �'-- -Liquid depth___�- Se tic Tank: _ No. of compartments----I------------------ ----- Distance from nearest well-----------------Distance from foundation-------------------Lining material__________ -------------------------- -(�\; Cesspool: ---------- V ❑ Size: Diameter Depth Distance from nearest well----------------------------------- ---- 'Distance from nearest building Privy: - ❑ Distance to nearest lot line---------------------------- �_Qr------ Depth----�---------------------- Distance to nearest well--l-A4 �- Distance from undation__�-�-------- t $e,to nearest lot line Seepage Pit: •`�4Size. Diameter____- ---- - Number of pits--------0---- Lining material -- - Q © Distance from foundation__ 5--------.Distance to nearest lot iina��---------- 1 i ___________ Disposal Field: Distance from nearest well-_/Q.___ _" Len Length of each line_____-____.o --------Width of trench_----- Number of lines-- '00 -- g ii Type of filter materiaLj_�__---'+------Depth of filter, material--- ------------ ------------- -Remodelingand/or re„airing (describe}:----------- y. - ,� e,..- �__ - , - ��- -------------- --- --------------------------------------- -------------------- -- ------------------------=----- --------------------------------------------------------- -------------------------ce--------that ------ye__----------ed-th------- I hereb certify that I have prepared this applicatio San the work Health Districtbe done . accordance with San Joaquin County ordinances, State laws, a\ rules and regulations of the q ------------------------------- ---( onTF, C -• 'ate ` Si ned ------ ------------ ---- ( 9 )- _(Title) ------------------------------------------------------------- ---------------------------------------- - � Plot pians, sho g size of lot, location of system relation to wells, buildings, etc., must be filed with this application . ( FOR DEPARTMENT USE ONLY E ---------------------------------- DATE----------73-14( 44----- APPLICATION ACCEPTED BY----------------------- "_"- "_""--__ __- ---- DATE--------------- - II------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------- Alterations and/or recommendations:----------------------- ------------------------ ------------ --- ------------- ------ ------------------------ ---•- --------------- ----------------------------------------------I--------- ---- ---------------------------- y" _"-_ _--- Date FINAL INSPECTION BY:------- PERMIT No._----4e--(------ ISSUED_ - ( 10 ------ . Date---�-.- - --- y SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street Stockton, California E5-9-2M 9-50 W=4639