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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) , - F 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. w JOB ADDRESS AND LOCATION_..__ �C�._ '---F-a-Ai ant..... ---------------------------------------------------•----------------•--------------- Owner's Name----- ,--az1Sj.-- ,g--t-__3y__1ve_8_t er---Malabar -----------In------------------------------------------- Phcne____4—_6_5EZ------------ Address-----------2-9-65--- s--------------------------------=--------------------------------------- ---------------------------------------------------- Contractor's Name---------felt&_.SaPt1Q--Tank__88rv1Cs------------ -----------------------------__-------------- Phone-------3.e__39L_ - y. Installation will serve: Residence] Apartment House ❑ Commercial L7 Trailer Court ❑ Motel ❑ Other ❑ ! Number of living units: -[0 Number of bedrooms I] Number of baths El Lot size----1- _ ____X___.6_0_ ____Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [_1 Clay Loam ❑ Cfay ❑ Adobe [NHardpan L] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------_Material------------------------------------ ___.________ No. of compartments ---------Ca Capacity ----Size--------------------------------Li th_____________ Liquid de 19xis t trig p - P Y------------------- q p Cesspool: Distance from nearest well-----------------Distance from foundation------------. ___.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well---___Y_________________________________________Distance from nearest building----------------------------------------- El "" Distance to nearest lotline--____________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----_--------- 2c] _____-__2 ] Number of pits-----]---------------Lining material_brjX,-k-------Size: Diameter_______ _______---___. f � _Depth_ __5�_>!, _-_kn_ .r Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__________-_-..__ [� Number of lines___._._1-------------------------- of each line----.---5-Q----------------Width of french-----x.81,----.----------------- Type of filter material_..._ro__ck--------Depth of filter material_______________________ Remodeling and/or repairing (describe):----------------------ra$&iring-------=----------- .---------------------------------------------------------------------------- --------------------------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------•-------------- ---------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County j ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)...........DG.lt_a.__S,ePtAa__T.ank_-Se-my-to-e- ____ _ _ -----_---------------_____________-_.------------AOwner and/or Contractor) By%.........Perry.---Iar_t.han--------- -- --------------------(Title)----------Q_wner-Mgr- ------ f (Plot plans, showing size of lot, location of system in el Ron to we s, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- DATE REVIEWEDBY-------------------------------------=-----.-------- --- -------------------- ------------------------ ----- ---------- DATE----- --- ------- •-------------- --------------f-.-••-- � BUILDING PERMIT ISSUED-------------------------- --- :* DATE---------------- Alterations and or recommendations- i ----------- - = e -----:-------------------,------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 4 ________________________________________________________________________________________________________________________________..__-.________-__________________-___:.---__________- __________-_-._________---.__________- _____________________________________________________________________________________________________________________________________________________________________..__---_______________--_-__________-______________-_--_-__ PERMIT No.-.d-..�Z.__/------- ISSUED---- ------.....-(Date) FINAL INSPECTION BY:----------------- ---f ___ -_ --------------- Date------------------------ - ----------- Date------------------------ � i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9--2M 9-50 W-1639