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APPLICATION FOR SANITATION PERMIT r �( [Complete in Duplicate) �� the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and installe This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATION---------- -120-_BEIRMANX---Be_lir-edera--------------------------------------------------------------------------------------- Owner's Name---------CT__.-__H,----0We11-------------------------- ' Phone---'3*sb- 7------------------ Address------------445---S_.....F - im----------------------------------------------------------------- --------------------------------- -------------------------------------------------- Contractor's - ------------------------------ Contractor's Name------0I--ta-------------------------------- .. --------------- Phorie--------�7t-3-955-------=--- Installation will serve: Residence ❑ n Apartment House g] Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: go Number of bedrooms 3] Number of baths [2 Lot size---.50X250------------------------------------------- Water --____________________ {Water Supply: Public system ® Community system ❑ Private ❑ i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 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_________________Distance from foundation--------------------Material________________----____----_-_-__------ e-xf �gg No. of compartments-__-----2----------------Capacity $4Q --Size-----------------------.--------Liquid depth Distance from nearest well-----------------Distance from foundation--------------------Lining material____.______:-.------- - ❑ Size: Diameter-------------------------------------Depth--------•-------------------- -------------- .-- , I Privy:, Distance from nearest well_____________________________________, Distance from nearest building _._______;_ ,_-_-. ❑ Distance to nearest lot line------------_________________________t------- h ___ - Seepage Pit: Distance to nearest well______________________Distance�frorri foundation_______._.-_______.Distance to nearest lot line____________-_ -. ' Number of pits--------------�..____Lining material_br—tak-------Size: Diameter___4�______________.De th-tom_. b '- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest of sne-______-___.___-- / [AX ist ing Number of lines------------ -------------------Length of each line-'=-------*lot----------------Width of trench--------—----------.------------- FType of filter material-__--"_________________Depth of filter material--------_________-___ r `Remodeling and/or repairing (describe):------1n5-t-&1!iX18--- -------------------------------- ---------------------------- ------------------------------ ?. . . ..--- + ` .,, -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' (Signed)----------------------•-- Ae I ag,---------------- -- --------- -------- =--------- ---------- ---- --------------------(Owner and/or Contractor) $y-------------Be z r f war'tion o s ste m r---t' n to w---s--buildin- etc- mustTitle]________Qwne—r,-M6j'-•--------------------------- (Plot --------- ------ (Plot plans, showing size y g 16-e filed with this application). FOR DEPARTMENT USE ONLY/ [ APPLICATION ACCEPTED BY.----------W------ .'- --- --- ---�-- �----------- ----------------- -- DATE FSRREVIEWED BY--------------------------------------------------------------- ---------------------------------------------M------`--------- DATE-------------------------------- 4 BUILDING PERMIT ISSUED------------ ------• ----- ----------------------- ----- DATE__--- n—CL 40! Alt rations and/or recommendations: - --- - -, �� 1- -- V� -,�- -------i--•�----fir -- �---��-..-�- -- '�-� - -�-----��-� _ - �---_-A c -ALi� r'�`ls.�_ t fi�Q R ' 141_x - -tl�r"� �tAs PERMIT No._,67'� ------- ISSUED---------- ______________(Date) FINAL INSPECTION BY:___________-W__t1_-:w-----------.-.-_..------ Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES---9-21A 9-50 W-1539 1