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;o APPLICATION FOR SANITATION PERMIT I, (Complete in Duplicate) j I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi lication is a in c liance with County Ordinance No. 549. '4 7-122 �" � JOB ADDRESS AND L CATION ----- ---- ------- ----- -- —. .. . �. �p 1 Owner's -�'L_-- -- ------------------------- -------------------------------------�� . Phone r •_ / � _. i Address ----------------------------=--------------------- # Contractor's Name___&A--- ,6N —--------------------------------------------------------------__ Phone---074?v_l 7 - 0 Installation will serve: Residence ❑ Apartment House ° Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 01 Number of bedrooms Number of baths Lot size______ � ___- /Z.Q.______ " :: Water Supply: Publics stem Community s stem Private PP Y� Y ❑ Y Y (] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay`❑ Adobe [ Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) II Septic Tank: Distance from nearest well----6.0•___Disfiance from fo ___.Materil__ undation_.__.. __-_ a ___ _ 1 No. of compartments--------- ----_______Capacity---�V__6_Q------Size__-�{� �. _Q_.`.Liquid depth___fcp_°---_,______ q Cesspool: Distance from nearest well.---------_------Distance from foundation--------------------Lining material_______________________._____________ ❑ Size: Diameter--------------------------------------Depth-------------------------------------"-------------- i� k Privy: Distance from nearest well________________________________________________Distance from nearest building------------.------,----------------------- - ❑ Distance to nearest lot line------------------------------------------------ , r y— Seepa ePit: Distance to nearest well ��y ____Dis+ance from foundation____�a_�______.Distancei to nearest lot Number of its________ '� p ,2 -- p �_._________Lining material____�.z:__Size: Diameter____ _�______ De th_____ ,*�'_________________ Disposal Field: Distance from nearest well___.j__0 ___.Distance from foundation--,__,l _`__.Distance to nearest lar line___�_0 '., ' Number of lines-------------�---- -- ____Length of each line___0V, -_fr0 __.Width of trench_____-,A_V ......... .____"_____ ,� A Type of filter ma+eri !_ _ _ !Lf Depth of filter material______l_c _��___ ` fp Remodeling and/o. repairing (describe ev�sv L!J c --'" - ' ---- -------- ----- 1'.l� .rx. -------------------•-•--- -- - -------------------•-- ------------------ -- "r ----- --------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ty ; ordinartces, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)___ �__,_ _--�--- ------ (fid/or Contractor By:. 4-Lt� 12G__4W_ -------------------------------------------------------------{Ti+le) �� I '0 -r�-------------------•-------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed withl this application). FOR DEPARTMENT USE ONLY �M APPLICATION ACCEPTED BY = DATE REVIEWEDBY---------------------------------------- ----------------------------------- --------- DATE.--------- I�1 ,_ar,---------------------- -•- BUILDING PERMIT ISSUED----------•-------------------------- --------------------- DATE---------- Alterations and/or recommendations-------------------------------------------------------------------------------------------- 1� i --------------------------------------------------------------------------------------------------------------•-------------------------------------------- ------- -------------------------------------------------d i ` I ---------------------------------------- ---------------------------•------------------------------•------------------------------..-----------------------------•--•----- ------------------------------------------ ---- PERMIT No-----�'�?} °.______ ISSUED ':_-_lir' _' ___"-_"________(Date) FINAL INSPECTION BY:_"______----_-v.,"__-�4 Date------------------I ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I� E u ES-9-2M 9-50 W�1639 Stockton, California �l it