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`APPLICATION FOR SANITATION PERMIT .. (Complete in Duplicate) j 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 -- f (a�7C': e cif.. -.---a'-��7..(�i^�3��r� «, c i'^owners —66 9& Name-- ---- - -- --- - ----- .... --,: Phone_ Addres ---- ------ -------- ------- --------- ------------ ----- -------- - ------------ --- ----- ----- ' Contractor's :Name------ I3�lta--------------- -- - <----- ---- -------- ----- ------- ------- -------- -- one ------------ -- Ph 3 395 Installation willserve :Residence ❑ omE]Apartment,House ❑ Cmercial Trailer Court D ` Motel E] Other ®afe - .��. �°i� s � - les Number of living units: E] Number of,be.drooms�❑. Number of baths [2� of size-___---__.-)5M.1--------------- Water Supply: -' Public system P9 ;Community system-'❑ Private E] Character of,soil to a depth of 3 feet: . Sand ❑ .a Gravel �] "Sandy Loam E] Clay Loam El Clay E] Adobes] Hardpan E] TYPE OF INSTALLATION AND SPECIF.ICATIONS Y. I'Mewer is,a 5e tIc Taokseptic t Dktancesf from nearest.,es�wellf publics Distancvailable within 200 feet.) T ------Distance from foundation--------1-O'-__-.Material--------- ? ;sj;-obi''s_ I_ ._.._. p No. of:com artments..- 2 r p - Capacity - g©� Size k4f x4 Liquid depth Distance from nearest well-----------------Distance from foundation--------------------Lining material----.----------------- ..._..---___. ❑ Size: Diameter----------------------••-=-------- ---Depth;--.-------.---.--------- ------------------------ Priv Distance from nearest well................... ' 'y; _---=--------------------Distance from nearest building--------_----------••----_--'- �F ❑ Distance to nearest lot line-_--_--_......................... Seepage Pit: . Distance to nearest well--------- Distance from{•�-,,foundation-------8'-... Distance to nearest lot Ilene_ ..-_ ----- [5� Number of pits-------�/ y . kMa Did,111 '$� ize: Diameter----- Q�.----- knin ma era Depth -------18 ' e____. .1 Disposal Field: Distance from nearest well-.....- Distance-from foundation-------5._.__---_Distance to nearest lot lin _..._._ Q Number of lines-... . " _ ' ngth of-each lire___3?3:a.3 O;t--------vY dthrof trench __2-1-- -__ . � Type of filter materia! Y'_p.0 _ ;,Depth 'of filter material,----18---------• ET { -- Inst2--t�.nk5 and avp. 30' of 1ea C' Remodeling and/or:repairing (describe):--------- :="_, Z -f-----r;--- - ---------------------------------------------------------- — ----- - a Lis--_ane-------I' t----__ ,12t ___ k?Q. �. F_._I,1? _,_�Q_-_2• .� r �l.i ._�1 G 'r, . _-71f---- S--�1�___� lta�________------------------ ------------ • Y ------------- ----- ------------------- f , -- ----- ---- ------------ - ------- -------- -- - = -- = - - hereby certify that l have prepared this apprcation"and thafahe work will be done in accordance with San Joaquin Coun I ordinances, State laws; and rules and' regulations,of'fhe'Sari Joaquin Local Health District. ............... -----=-------------------------------------------------------------------- (Owner and/or Contractor (Signed) By:----- w y :, -------------(Title)------ownex'--11S-r------------ ----------------- 1'_e— wartha:n--------------•- - - - (Plot plans, showing sae of lot-. location of.s�stem in relation to wells, buildings, etc., must be filed with this application). FOR-DEPARTMENT,USE ONLY APPLICATION ACCEPTED.BY---- '------------ ------ =--------------- ------ ------ ---- ----------------------------------------------- -------------- ------------------------ --------- ' .�' x - - , ------------- DATE------ - -- i REVIEWED BY------------------- ---------- = - - BUILDING PERMIT ISSUED----------- -= --------------------------------------- DATE lC . . :,Alterations and/or.recommendations:------ - -------------------------- --- °`----------•------------------ t -- .. .K' -------------------------------..------------- -----------_--------. .._-' --------------------- --------_------------._....---------........--------.......-----.--......-..----------------------- ----.. Q t PERMIT No.__�_ -.. ISSUED - •� J_---(Date) FINAL INSPECTION BY----------------------------------------------------------------- .. Date-------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639 --- � -