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APPLICATION FOR SANITATION PERMIT s zr (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a ~ This application is made in compliance with County Ordinance No. 549. permit to construct and install the work herein described. JOB ADDRESS AND LOCATION... u u Owner's Na -� �I --------------------------------------------------------------------- -------------me ��//�� y� - 'y'1--�--'f�'-r EL_T�µx�•r��7 _ ----------- ----'-- II --+�✓Nii.i�4.LL.F RE.--------~ ------------------- --------- --------------- Address-- -------------- Phone.--��oa7t9------------- ------------------------------------------ • -Contractor's Name------------� ------------ -------------- ------------- ---------=-------------- r Installation will serve: Residence© Apartment House ------------------------------ ------ Phone..----3--39 ' ❑ Co Number of living units: Number of bedro ❑. Trailer Cour} ❑ Motel ❑ Other ❑ Number of baths I Water Supply: Public:s stem' ® Lot size- Q5 ----- I ] Community system` Y Y Y ❑ Private ❑ _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.❑ Clay ` TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ Adobe [} Hardpan ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet. rr EXIS ISM, Distance from nearest well---!k EX from foundation---3-1-----------Material------_---�?�� 1 p �wCr No, of compartments_.-__-__. 4'e i�. CapacitY - Size - ---------------------Liquid depth ;. Cesspool: Distance f•1om nearest well............._.-Distance from faundatian_..__._--_____ h 0 Size: Diameter--------------- ----Lining material----------, V } Pri Distance t�� Depth ------------------------------------- Distance. Y� from nearest well.............._-_- _ ______ __._� --------_..Distance from nearest building ' o nearest lot line_ ---------- •---------------------- - Seepage Pit:. Distance to� nearest well- ---- "'------------Distance from foundation.__- tr � ® Number of pits-----I-_-- 8 -----------.Distance to nearest lot line..---�; Lining material.._-}Jxj_Q!r___-Size: Diameter---------------------(-.Depth------2-0... r SCZDisposal Field: Number'ofom nearest well.----_.--..__.--.Distance from foundation_ __ ' lines--.-_--I---------- -_ Length of each line._ -------Distance to nearest lot line------------ -- .�� Type of filter material___-.------------------- -�j3. ----.Width of Depth of filter material___----_--_r__..---_.� Remodeling and/or repairing (describe):-----------------149t 3.3 449--M�yT OY'aYl. �,_Cita ns� solid ! xs :� ?� .. G.. k"�_ o � yet 1 dram - = , 1, � � gram ---- ------------ ----- ----- I ----------------------------------------------------- Y Y - - ---I' - Y ------------------- ---------------- ----------------- -- ---- ---------- prepared This application and that }he work will b-- done in--- ---------------------------- ------------- I i hereby certify Mat I have re '_ __--------- I State Paws and rules and' regulations of the San Joaquin Local Health District. accordance with San Joaquin County I (Si gned)----------------D-e-ru I }._ -------------------------- --------•-------- (O B y _ a�xx.. D w r Contract net,and/or or ---------------------------------------------- •----------------(Title]_ OZT3IBY',..T;j r 1 ( p - Y•-�--------� 9�� ----�a cation of system in relation to wells, buildings,'etc, must -- -�------ ---- �-�------ ------------ (Plot lens showing size of lo+ to q�' g be filed with this applica+ion), 1i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._.I_ - - ~ 7 -- - -- -- - ---- ------ --------------- ---- ,REVIEWED BY----------------- �M :- - - - ------ ----- -------- ------ ------ ------ ----- - -- DATE----------- ' " BUILDING PERMIT ISSUED I� DATE ----------------`----=--------- A terations and/or recommendations:_ =- DATE ---------- --------- --=---------------------•------- ------------ --------------------------- --------------------------------------------------=--------- -------------- ------------- --------- -- ----------- ----------------------------------------------------------------------------------------------------------------------------- PERMIT No -- - -- ---- - -- - --------------- --- ----------------------------------- ---- �` f____(Date) FINAL INSPECTION BY-- --------- ------------•� 4. ll! ------ ------------------ - Date ' -- F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9 -2M 9-50 W-1639 Stockton, California �