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x APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 474 a 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. I JOB ADDRESS AND LOCATION --- r' �� rx ------------------------------------------ Owner's Name-------'? $ 1 i �j liCh--------------------------------------------------------------------------------------- Phone---,2=7�5__P_3--------- Address-------------------f�-� � ....... --- "a�v-------_''�--- ---------------------------------------------------------------,--------- --------- --------------- ve Contractor's Name-------� !� Ali !_`- - --- -- pfd ':x czfi----------------------------------- Phone_-�_ 3�7— Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ZI Number of bedrooms 0 Number of baths m Lot size---Sl__D__'2K---/..XO__�_________I_________________ Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ckay Loam fl Clay ❑ Adobe [@ Hardpan ❑ a1113 TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_________________________________________--____. ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________--______. f [] Size: Diameter--------------------------------------Depth--------------------------------------------------- } Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building------------------------------------------- El Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well______ ___Distance from foundation--6 Distance to nearest lot line_____ ® Number of pits____________________Lining material Size: Diameter____ Depth Ccr+-� - I�=K f,To E rTrTw - Disposal Field: Distance from nearest well------------------Distance from foundation---------------------Distance to nearest lot line_________ _._____ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material________________________Depth of filter material----.-__.---___________ Remodeling and/or repairing {describe)_________ ----------------------------------------------------------------------------------- ---------------------------------------------------------------- -------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify.fhat I.h�ve prepared this application and that +he work will be done in accordance with San Joaquin-County t ordinances, St to laws, al'd rules and regulations of the San Joaquin Local Health District. -- (Signed-- ---- -'l...�..+F_fi. ~ �f'1-S -` Tn___�-r--------------------------------------------------------{ Contractor) r By:-------------------------------------------------------------------------------------------------------------------------------------{Title) - -h -e�lc'-1 .._----------------- "~ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- - DATE_____--__ --------------------------------------------------- REVIEWED BY-------------------------------------------- -------------------- -------------------- -------------------- V-1/7 ----- --- --------- -- ------------------------------ DATE----- --- - BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommend ations------------------------------------------------------------------------------------------------------------------------------------------------------• ------- ----------------------------------------------------------------------------------------------------------------------------------------------------•---------------.....------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- _____ ISSUED_______L__-_�_-__________________{Date) FINAL INSPECTION BY:________ ----------------------------------------------- Date _-_ /7/-- PERMIT No._-_---_�71-. 1 Date---------- ----------------------------------------- z------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9.50 W-1639 Stockton, California