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APPLICATION FOR SANITATION PERMIT O Q 0 (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-----------------------104,- �lx'kett Owner's Name----------X3r_t_inMaliat-ot--------------------------------------------------------- ----------------------------------------- Phone---3-6 4-44--------------- Address--------76__0___W4tts___Av --------------------------------------------------------------------------------------------------- ------------------------------------------------------------- k -Contractor's 'Name---------1e_lt.-: ----------------------------------------------------------------------------- ---------------------------------------- Phone__3-3955-------------- �t .Installation will serve: Residence M Apartment House ❑ Commercia€ ❑ Trailer Court ❑ Motel ❑ Other ❑ g Number of living units: Number of bedrooms E]. Number of baths El Lot size_________4OX18D----------------------------------- Water Supply: Public system [K] Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E?j Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- DM T ING ____----------_---_____________-_________ _-DMTING No. of compartments--------------------------Capacity-----------------------Size---------------------------------Uquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material------------------------------------ - , - ❑ Size: Diameter--------------------------------------Depth------------------------------ -------------------- Privy: Distance from nearest well____ _____________________----------Distance from nearest building_--------__-____________________--_---_ i ❑ Distance to nearest lot line_______________________________________________ Seepage Pit: Distance to nearest well_______ -----------Distance from foundation----l0---------- Distance to nearest lot line-----51_______ ® Number of pits___-_�_-------------_Lining material____Dr'iek___. Size: Diameter____ Depth .' ___; .,,--__ --Disposal Field:- Disfance frpm-nearest�well:x-__z::_.--Distance from foundation-------------'�--D-rs+ance�to=neares+--lot-line__--=" - EXI]PLNG Number of lines-----------------------------------Length of each line------------------------------Width offrench----------------------------------- Type of filter material_________________________Depth of filter material----------------- Remodeling and/or repairing (describe):-----Tnsty.11ir_�__v-er_t_ic-al--drdin---only____to_-_take--_care___o_f__t he___- ----kite-hen---slrk---and-- the--w-a.sh--tray---- ,rest----af----tom'---ho-use----oea---int-o---�--r_eSu1_ar-----------= - ante- -fc---ta-nk---s-}2t_em------------------------------------ --------------------------------------------------------------------------------------------------------------------------------- —.. 4 ---------- --------------------------------------------------------------------------------- I 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)-----------D e_lta-------------------------------------------------------- ------- - - - caner and/or Contractors } B ---------- Rerrv__�I rthaxz__ �, r=t `+ - - ----- ----------------------- Y� - 3 _ ----------------------------------------(Title)--Ow- t x' - „(Plot plans, showing size of[of, location of system in relation to walls, buildings,.of c., must be filed with this application). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- DATE----- --------------------------- ------- --- - -/ -- -- ---------------------------------- BUILDING PERMIT ISSUED -------------- 'r DATE_ �d,.� REVIEWED BY--------------------- -------------- ----- ------------------------------ DATE----------------------------- -------------------- Alterationsand/or recommendations----------------------------------------------- --------------------------------------------------------------------------- ---------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ----------------------------------------------------------------------------------- i -----;-------------------- -------------------------------------------I----------------------------------------------------------------------- ------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- ---'----------------------------------------------- ------------------------------------------------------------ PERMIT NAQ_��'_____ ISSUEDeW_--4__��-.S`�-' Date) FINAL- INSPECTION BY:.-_ o- ' - ---- -}__ ---------------------------------- - f Date-, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street �V Stockton, California ES-9-2M 9-50 W=1639 �~ _f