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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 work herein described. This application is made in compliance with County Ordinance No. 549. s;7 ' JOB ADDRESS AND �LOCATION_;-- ---- - -Q-f-- ��------r-'�---PF t-A'-SNE--- I" - Owner's Name----------yL`-�-1-P-A--------it------ G ��N N ---- ------ Phone----- -------------- Address---------•...�--q---1,r 2F--k Contractor's Name--:----1� P,- k---- `- Phone_3-sP°2 l� I Installation will serve: Residence ® Apartment House ❑ ,Commercial-❑ Trailer-Court-E] Mot el -❑ Other Elm Number of living units: [� Number of bedrooms 0 Number of baths ,r Lot size-__-________il�;4___:)(__1�__________________ Water Supply: Public system ❑ Community system �''Priva.te ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑� Sandy Loam ❑ `Clay•Loam ❑ Clay ❑ Adobe �, Hardpan ❑ All 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___NPNB___Distance from foundation------1p___._,..Maiierial_________ +�_G__ _ 7-__S�_______ -fir No. of compartments-----------4;--------------Capacity----- *140---Size----3 Liquid.depth----------- -- --------- .s Cesspool: Distance from nearest well_______j___-.__Distance from`foundation__________________.Lining material-------------------------- ----------- ❑ Size: Diameter---------'---------------------------Depth--------------------------------------------------- Privy: --------------- -----------------------------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-------•------------------------- r �+ i ,-,Disposal Field: Distance from nearest well-Js�o-w_�__.Distance from foundation ----�d----------Distance to nearest lot Number of lines-------------%------------------Length of each line__hYD_ -------.Width of trench-------Z._,----------------_.____ � Type of filter materialL�4-X'h41�k-----Depth of filter material__----?>?"__________ -Remodeling and/or repairing (describe):-------------lY�a-o---- t -><3 4 4-0-------------------------------`----------------------------------------------------- ------- -- -------•---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa laws, aydules and gulations of t e San Joaquin Local Health'District. (Signed)_______ _ ____ ___ _____ -- ----------------_------- Owner and/or Contractor ( / ) By:----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE'D BY----------------------WA _4-------------------------------------------------------- DATE---------- r 0= REVIEWED BY---------------------------------------------------v4--d-- :W • ------ DATE----------- Q_"' '-�---`------------------ -- BtJILDING PERMIT ISSUED ------------------------------------------------ ------------ DATE------------------------------------------------------- -- Alterations and/or recommendations--------------------------------------- ------ - ---------------------------------------------------------------------------------------- `s ------------ --------------------------------------------------------------------------------------------•--------------------------------------------------------•-------------------------------------------- ------ --------------------------- ------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ---•------------------------------------------------------------------------------------------------------------------ f PERMIT No.-D,-95 .-- ISSUED------ = ---------------(Date) FINAL INSPECTION BY:---------- --f----- -------------------------------- Date----------------- --^---a --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-50 W=1639 }