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I =- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) J Application is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION--------- Owner's Name-_Pq"11 -P'''--- ��iYIG 2�. ___ ly1YIlQ -Y .-'- .t29 '------------------ Phone---- 1- Address ---------------------------------------------------------- �i ----------------------------------- Contractor's Name-------------------------------------------•---------------------- --------------------------- -- -------- Phone Installation will serve: Residence 9Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ❑ 'Number of bedrooms m Number of baths ❑ Lot size------- \j Water V E Water Supply: Public system ❑ Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay ❑ Adobe-0 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-----------------Distance from foundation-------------------.Material ___-No. of compartments Capacity-------------=---------Size Liquid depth- ------ ------------ Cesspool: ------Cesspol: Distance from nearest we1L_--Q--------Distance fromfoundation-____/_�---._-___Lining material_odw, 1-----------Size: Diameter---6 �Cz-�'_- X- -------------Dept h---------_-6- I Privy: Distance from nearest well-__-____-___--_____.__•- - ---Distance from nearest buildingI------------ ---------------------- ❑ Distance #o nearest lot ____ line---------------------------------- ---------- - Seepage Pit: Distance to nearest well----------------------Distance from foundatibn--------------------Distance to nearest lot line__---�:--__-__ , ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------_''--:-----_-- i, _Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----_I�- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french-----------------------1(----------- ---------- Type of filter material----- ---------------Depth of filter material----------.-__-_---_--_ Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------"---------------------- ---------------------"•--------------------------------------------------------------- ----------------------"----------------------•--------------------------------------------------------------------------------------- II I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__14� ------1 •-=AFS-b-^- `7 ' --------------------(Owner and/or Contractor)I By:-----------------------------f---------------------------------------------------------------------------------- --------------- Title ----------- ____((Plot Plot plans, showing size of Iof, location of system in relation to wells, buildings, etc., must be filed with this application). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -L�' �--- a------------------------------------------------------ DATE- ,� / J� IR BUIL ' BUILDING PEERMI WED ------------------_ ----------------------------------------- ------------------------------------------------------------ DATE-------------------------------------------------T ISSUUED - -------------- -- --- --------------- DATI= Alterations and/or recommendations-------------------------------------------------------------- - -------------------•--------------------------------------- 1I ------------ ------------------------- --------- --------------------------------------------------------------------- -------------------------------- -------------------------- - 1` JL --- ---------- PERMIT No.15-.-4v--_ .� / -- ----- ISSUED------------------- ----------- --------(Date) FINAL INSPECTION BY:------ ------- -------- -- --,�- - -- ---- ------ - ----- Date------------------- - I SAN JOAQUIN LOCAL HEALTH DISTRICT 1� 130 South American Street it Stockton, California ES-9-2M 9-50 W-1639 II