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r APPLICATION FOR SANITATION PERMIT y� (Complete in Duplicate) 6A4e-0 . Application is hereby made to the San Joaquin Local Health District fora permit Th" application is made in compliance with County Ordinance No. 549. p m t to construct and install the work herein described. JOB ADDRFS5 AND .LOCATfON______l4&3_4-------F , r Owner's N me _, ��_-:-_---FIRAlyCf15 - ----------Gi��-T-a----------------------------- - ------------ ----- --------- Phone--,t74-9$1----- Address .04------E- t�,te/Q%k}r -K -- ------------------- ---------------------------------------------------- ontractor's Name Phone Installation will serve: Residence ❑ Apartment House ❑ Commdreial ok Trailer Court ❑ Motel E:]- Other Number of living units: ❑ Number of bedrooms ❑ Number of baths. Lot size-------- ❑ - ___ ------------ Water Supply: Public system Community system ❑ Privato F-1Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E2/ Adobe Dt Hardpan EAJ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Mat erial-------- r� C� F X, No, of compartments--____�'--------------Ca � Aq- ------Size pacitY-------- ------- --------------------------------Liquid depth-- --4.r------- ----. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--Size: Diameter--------------------------------------Dept h_------------------- 1 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__-____-_____- -_ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter--------------- -------Depth-------------------•- �kj I' = >-Disposal Field: Distance from nearest well------------------ from foundation._______ _______ Distance to'nearest loj line-_-�"�- Number of lines-----------Z_-_ Length of each line------------ "Width of trench______ , rr p ri Type of filter material_________-`_` Depth of filter material and/or repairing (describe)----------------------------------------------------------------------- ---------------------------------------------------------------------------------------- �= .. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ations of the San Joaquin Local Health District. `- --- ----------------------------------------------- -------------------------(Owner and/or Contractor) By%---------------------- Tale (Plot plans, showing size of lat, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __ � :- ------- ------- -- �j--�--- --------- --------------- DATE------- REVIEWED BY--------------------------- ---------- -------------------------------- DATE �' ,t UILDING PERMIT ISSUED---------•--------------------- - ------------------ ---------------------- - --------------------------------------- DATE Alterations and/or recommendations______________________ ------- ---•----- -----------•----------- ----------------------/-------------------------------------------•-----•----------------------------------------------------------------------- ------ //�L, ISSUED_----_ _f�_/.f'� PERMIT No.___`7--_-9 / 7- ----(Date) FINAL INSPECTION BY:_________�_-V Date. (7--'-- /+ ----------------------------- --"- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W4639 Stockton, California