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APPLICATION FOR SANITATION PER�ylyllT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and instah¢work herein describe Thi a plication is made in compliance with County Ordinance No. 549. D�"1 - 4y-tk JOB ADDRESS AND LO TIO/�j-. _c7t�I�l_�--___ .lQ_tuQ '�--_!lf 0115rR..___ r-_- Owner's Name------C.1 Z. -- LD' -(- - - ------------------------------------ Phone------------------------------ Address------------- ---657A. -d R I �� --9 - Contractor's Nanne...._--------- -.. .0... Kx�$ ---d`-- 105,-_. t�G°.. Phone.,77!-_ ------ Installation will serve: Residence ❑ Apartment House ❑ Commercials Trailer Court F1 Motel C] Other E] , Number of living units: E] Number of bedrooms E] Number of baths ❑ Lot size._,X5'P------ Water Supply: Public system ❑ Community system ❑ Private X 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 _fb�__Distance from foundation__./..Q--_/.40 ----.Ma} rial__0QKC*7W�_____ No. of compartments__- Capacity/ x.!M__ti.__� Q..___Ca acit .BfU..r1i9�.-Size _-__ _�.lgwd depth_�io-___._____,. Cesspool: Distance from nearest well----.__..-------Distance from foundation--------------------Liming material----___---___----______-____. ❑ Size: Diameter--...-------------------------'-----Depth------------'------------------------------------ Privy: Distance from nearest well----------------------------------.-------------Distance from nearest building ❑ - Distance to nearest lot line__------------------------------__.-.-.__. Seepage Pit: Distance to nearest well Distance from foundation-_.................Distance to nearest lot line.--- 171 ine._❑ Number of pits----------------------Lining material. ._.Size: Diameter___---------------------Depth----------------------_- r �� ' r Dispo;al Field: Distance from nearest well-- --Distance from foundation_ _._ _-__-__--Dis+ante to nearest I t line_v____._ lf#\ Number of lines.... ___ _- __ Length of each line___I.�-Q____-___-Width of trench.-��..�<.,{_'� Qng� - Type of filter material Depth of filter material__- ±.I----- -Remodeling and/or repairing (describe):.-_ _.. ----------------- ------------ --- ..----- ---- -- yy '. �y/ ------- ----- --------- - YLlfl1F- -0[:_Y ---- - - ---------- ----------------------------------------------------------------------- = ... . I-------------------------- ------- - ------------------------------------------ --------------------------------------------- I hereby certify that I have ared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, d rule, an regulations of t San Joequ: Low) alth District. 1 Si ned 1 9 ) ,.� --- -�------h- -. -- -� - � (Owner an Con actor] (Plot plans, showi g size of lot, location of system in ation to wells, buildings, etc., must be filed`lvith this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - - DATE ----- - - - -------------- _ REVIEWED BY - - - -------------- - - DATE -� - / BUILDING PERMIT ISSUED------------ - - ---- ---- --------------- - -- DATE_------------------------ / ----------- Alterations and/or recommendations------------ -----------------------------------------------------.........---_----------------------------------------- - ------------------ - -- -------------------------- -------------------- --- -------------------------------- - ------------------------------------------------------------------------------------------- _----------- --------------------------------------------..............-------------------------------- ...- --------------------------------------------------------------------------------------------- ------------------------------------- .- ----7.6 ---------------------------------------------------------------------------------'----------------- --- No Q_ - _ ISSUED________- ---or- 3.-_(Date) FINAL INSPECTION BY:.__-._____L�-.-.... _r ---�?_ j-.__.__ /--- Date--------------------- - I�� ,,1 --- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639