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s APPLICATION FOR SANITATION PERMIT l (Complete in Duplicate) Application is herebymade to the San Joaquin Local Health District for a permit to Construct and install the work herein described. This appication is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-------------6.01_8-,_ F-r_�_sno--------------------------------------------------------------------------- ------------------------------------ Owner's Name-----------8_eri_-BY_OkJI7--- ---------- --------- - ------------- ------------------------------------------------------ Phone----2-99-i5_9--------------- ----------------------- Q1- -5 Address---------------------- - ---.--- --r2,`.€uQ---------------- ------------------ -------------- ------------ - ------------------ -------------------------------------------------- .. Contractor's Name---D_l a----------------------------------------------------------------------------------------------------------------------------- Phone----3--.'1.95-------------- Installation will serve: Residenci Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: M Number of bedrooms ® Number of baths El Lot size-------59�'100- ___________________ Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3: Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_______r-___,---Distance from foundation____-5-1----------.Material_-___-Ved7nWQ0d_______________ M __-- EXIU G No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth---------------- - r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- i ❑ Size: Diameter--=-----------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well______________________________________________Distance from nearest building----------.____________________:________. ❑ Distance to nearest lot line_____________________________________________ Seepage Pit: Distance to nearest well------Tin-------------Distance from foundation____._____-____.Distance to nearest lot line---5_r--------- }© Number of pits---3----------------Lining material__brick______Size: Diameter______41----______-_.Depth---_______2Q'__-.----_______ 6 Disposal Field: Distance from nearest 'well----------------_.Distance from foundation--------------------Distance to nearest lot line____----________- EXIU ITvG Number of lines------------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material---_-___________._____ -Remodeling and/or repairing (describe)-------------Inst_alLing__new---uertj!C_a1__drain---appraximate_y___2,0!nf .- _frn1L__sa-atic---t-ank-_,whi-ch---jz_-_exist_ aEd._.hookir.gup---to---5X-1;3t_� seI--- - --�_ -1 W_1tJ3 --sa-1id---lame---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- - --------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulations of the San Joaquin Local Health District. '(Signed)------ -Pert'- ---Wart_hcan---------D2 Del'. )---------------------------------------------------------------------------------------(Owner and/or Contractor) By: parrtarharz_ 1 - wne ----------------------------- --------(Title]pr-z�iSr_,----------------------------------- r (Plot plans, showing size f lot, location o system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE O LY oil APPLICATION ACCEPTED BY '`' - --- -------------------------------- DATE _- 0--'p� REVIEWEDBY------------------------------------------------------- ------------------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------:--------------------------------------------------------------- ------------------------------- ----- ----------- --------------------------------------------------- --------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------- -------- --------------------------------------------- - ------ - -- ------- --------------- --- ------------------------------------------------------------------- PERMIT No.__�( ---&---- ISSUED------------ ---�------��(Date) FINAL INSPECTION BYE- ------- - - Date------------- - ------- -- ----2-2---- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES- ,9-2M 4-50 W-1634