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S a v M1 „APPLICATION FOR SANITATION PERMIT 7 (Complete in Duplicate) Application,is hereby made to the San-Joaquin Local Health District for atpermit to construct and install the work herein described. This application is 'made in compliance with County Ordinance No. 549. JOB ADDRESS'AND LOCATION--------------------------- -------------------------------------------------- -- ' ------ Phone--4----0-36J------ ---------- Owner's Name------------T-*---�'�---s�i7_}1r1&0?'L---------- ------------ ------------------------ ---------- ---------- -------- Address-------------1 ----------=-- '�-------- ..�" --1-------------------------------------------- Contractor's Name----------Re-]...t�i----------------------------------------------------------------------------- --------•__ Phone--------3-39-}5---------- a Installation will serve: Residence [IC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [2Number of bedrooms [!]' Number of baths El Lot size__ _C ------------------------------------------ Water Supply: Public system:L] Community system ❑ Private X � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan y f. TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or cesspool permitted if u'6RC sewer is available within 200 feet.) F q� -F, . ---- v Material -E'E Distance from foundat.ion.___ Septic Tank: Distance from nearest well__ _- -------=--- Sizer -far-----------Liquid depth------------------------ No. of compartments----------------- - Capacity-------800------ t Cesspool: Distance from nearest well ---__ ___"'__Distance from foundation-------I-r- --"_ _:__L'sning mYaterial'______ _______r____ -___. ❑ S¢e: Diameter_.--------------r.-------- =� -:Depth �----------------------- - � 1 � I -r f ____°__Distance from nearest building Privy: ��Distance from nearest well----------------------------- Distance- ______ - " ----------------------------------------- Privy: ____""""_________________ """" " "'" ❑ Distance to nearest lot iine------------__r_ _ """----------------- --- �' Seepage Pit: Distance to nearest well-_____-4--7P--_Distaneelfrom'foundation:__,. L"�Dist nce to nearest lot line�___�� ® 5 brick__Size: Diameter------ref_- Zt .Depth--------f�--------- -- �11t t Number.of pits-_________I_-_-_____Linin matenal____f__F c� Disposal Field: Distance from nearest well___�5=-_____.Distance from fourdation______ "�-___ Distance to nearesf lot lice___-- -______ ® Number of lines------1-----------------_------Length of each line-------50/------=------Width of trench________-_-""-------------- Type of filter matenal-------Y'ozk-___._Depth of filter material___1811-__________- i � (describe): sT - -- ---- ------------ Remodeling and/or repairing ine— � W-----------.-------------------- ----------------------------------- ------------------------- --- - I ' = ----------------------------------- ; - - --- -- 1�.. C a' p r ------------------------------------ repared this application and that the work will be done in accordance with,San Joaquin County I hereby certify that I have p ordinances, State laws, and rules and regulations of the San Joaquin Local Health'District. (Owner and/or Contractor) (Signed) -De_�.ta---Sel-at L 1�__>�- - . - --- -- -- -------------------------- BY: Perr �- Perry -than---- T ------ (Title) 03a3zS-lr'-' --------------------- - (Plotplans, showing size of lot, location of syst i elation+o Is;buildings, etc., must be filed with this application). OR PARTMENT USE �INY .�.; . . - DATE------------ APPLICATION ACCEPTED BY f ----------- - - ------------- ------ ---------- REVIEWEDBY------------------------ --'----------------------------- -------------- ----------------- ------------f--------- }--- DATE------------------------------------------------------- BUILDING PERMIT ISSUED-_----------------------------V ---------------------- DATE---------------------------------------------------------- . - -------------- Alterations and/or recommendations---------------------- - ----------- ----------- -----'------------------------------------------------------- --- --------------------- # *-- ---------------------------------------------------- -------,---- ------------------------------------ -w .,J r- /�� = ----------------- i - j2- - -- _ -- --------------------------------------------- - ------ ISSUED_-j -----_ Date FINAL INSPECTION BY----------------- ---- - Lt�� PERMIT 1141-7--f- f�-- �-- � � � �f---Cy-t� Dare_--------------------------z --------- --------- ---- I + ' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , Stockton, California ES--9-2M 9.50 W-1639