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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the we erein described. r This.application is made in compliance with County Ordi ce No. 549. it �' -2�- O� � wn --------- --- = JOB ADDRESS ANDOCATION_______. �f�____�__p_ Owner's Name_------4--1------TA----------- ,J 1�[_-�<-Y-�-- r�_ 1. - ----------- ---------------------------- Phone_` Address----•- -------------- 6----------14: --------le:514-�------- - � 1 -------------------------;---------------------- �Q - /� 1-6 f� - -C/� ,o hone Contractor's Name------ � l ---------P ! fi P Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- Number of bedrooms Number of baths Lot size---_`" "" "__, d____________________---------- Wafer _____ ___Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan C TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1L��/_I�°6 Distance fr m founda ion___ _-�___ Material---- Se - J______-_- No. of compartments__ C-------Capacity_N£d50�-I,Size--- ---XcS__X_'7__--Liquid depth- ____________- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material__________________-____________ ❑ Size: Diameter--------------------------------------Depth----------- ---------------------------------------- !'Privy. -------- -----------------------------!`Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________:__----.-_--_---__________,� ❑ Distance to nearest lot line________________________________________________ See a e Pit: Distance to nearest well_Ak KC_____Distance from foundation-4A--._______.Distance to nearest lot line________ k r� , - " Number of pits___�J_ff_�-�r__-----Lining mate ria l�D�/e__��a-Size: Diameter____--__-------Depth___ ----------________ i r S/ - Disposal Field: Distance from nearest well_NQ/_y�._Distance from foundation__`1.�____-___.D'sstance to nearest lot line---Sf____"".____ i fi Number of lines---0��____ __ Length of each line_____�.�"___ - Width of trench_ _____�__-_-"_______________ of filter material i_��X=Depth of filter material_____ -------- Type Remodeling and/or repairing (describe): -- -- ---------7-------------- - ---- - --- ---------------------------------------------------------------------------------- ---- --- ------------- - '4'4'x' -------------------------------------- ------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared t ' pplication and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rulesn reg atio of the San Joaquin Local al+h District. 4. 1 4' -----imu O1-�I_ {Owner and Contractor] (Signed)--------•- !. 9 By:----------------------- �---�---------- (Title}{Plot plans, showing size of lot, location of system in relation to wellbuildings, etc., st be filed h this application). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________________ . --- --- DATE _ _ { --------------- REVIEWEDBY------------------------------------------------------------------------------------- ----------- ----------------.DATE-------------------------- ------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Aiterationsand/or recommendations------------------------------------------------ -------------------------------------------------------------------------------------------------------------- s -----------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- ------------------ ---------------------------------- ----------------- ---------------------------------=----------------------------------------------------•-------------------------------------------------------------------------•------------------------------------------------------------ ------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No. -7------ ISSUED------- -.� �`1-----(Date) 'PENAL INSPECTION BY:--------- 1--U--r"------------------------------------- Date----------------------------------------------- v��------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California k ES-9-2m 9.50 -- "� r.