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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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------lio uh 99 Jiivvv ay, Stockton, Cal. _� 6 tone :" Q vC � - - Owner's Name -----------'---------------------------4---- -------------------•---------- --------------------- •-------- Phone-_!.-ii<----- --------------- n .. Address--------------------- -_Pic�rth- '99 H i;r�. Flab ozl c�i e a i CLQ voz' 1v z - o 1, ------------------------ D.A. ?rra'7 sh e,' 6ox1s� Tn —x.5 7 Contractor's Name----------------- ----------------------------------------- Phone---------------------------------- Installation will serve: Residence n Apartment House"❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: M Number of bedrooms (2 Number of baths 91 Lot size-------7_5_1.___x -'- 0 T ------------------------------------------ Water Supply: Public system ❑ Community system ❑ Private ZI Character of soil to a depth of 3 feet: Sard ❑ Gravel [❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe:] 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__ ��_�____f}istance from folonoundation___-_-_�____ MaterialCon'___'911,,o' ___________________ No. of compartments =' `-------------Capacity-------=-------- ----Size===-------------------- --Liquid depth----2----•--------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------- Privy: Distance from nearest well________ ______________________________-_______Distance from nearest buil&ng----___----------------------------- 171 __._-____.__________-._ ___❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----1.) --------Distance from foundation__�-n_t________-.D' tance to nearest lot line 10 Number of pits...G'?------------Lining material__COP -'___B_I'Size: Diameter__---------- --------Depth_anro-x----__ ----_j___ co Disposal Field: Distance from nearest well__d 0-.____.Distance from foundation_____1- .........Distance to nearest lot iine_.__1_-------------------------- Number of lines_______0. t__-------- 7 r 1 -Length of each lire Width of trench--- Type of filter material- r=_!� x'© �_=,Depth of filter material__;-'�___._.:".__._ -S Remodeling and/or repairing (describe):---------------------i:+ r___--5 `'---------------------------------------------------------------- -•--------------- --------------- ----- ------------- --- - -------------------- ------------------------------------------------------- - y --that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,. State s, and rules a egulations of San Joaquin cal Health District. (Signed) �- __________________(Owner and/or Contractor i By-- ------------------ f --------Ca. -- - ---------------------------(Title)------r r1: i_]_43.(; , (Plot plans, showing si a of lot, location of system in rela ion to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__________________________ __ __ � DATE--------'• -ry- REVIEWED BY4� _ s � - ----------------- -----------------------------------------------------------------------•------- DATE r BUILDING' PERMIT ISSUED--------------------------------------------------------------- ------------------------------------- DATE------------- Alterationsand/or recommendations---------------------------------------------------------------------------------------------•------------------------------------------------------------------ --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ----- ----------------------------------------------------------------------------------------------------- PERMIT No.__ZG__�7--------- ISSUED----�/"- -- -7:�------------(Date) FINAL INSPECTION BY:----------------'_� -----V.__-------------------------------- Date----------------- -------------- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639