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S APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) i 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. JOB ADDRESS AND LOCATION _- E �� - 8Q� Fungi von?.- S voceion 1 Owner's Name--------------------- -- -- X30% ION 64' �' V-" PeterSor Phone-------2-�-Z43_5------------ I :801---F�zn@ton__Ave-------------------------------------------------- Address----------------------------- ---------------------------------------•- Contractor's Name------ RARR SH-.&---o50-5-1---Kj-------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms M Number of baths J3 Lot size----8.'___x_-10_ f----------__--_.- Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeigj Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2QQ feet.) Q Septic Tank: Distance from nearest well!'nne__-_.Distance from foundation-------------------.Material--___---___--____---_-_-__---__--_------------_-` No. of compartments--------------------------C-apacity-----------------------Size------------------------•-------Liquid depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_---------__------._---------.____-. Size: Diameter-------------------- -----Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------- Distance from nearest building_-____--_--__----------_ ❑ Distance to nearest lot line:----------------------------------------------- Seepage Pit: Distance to nearest well -------- from foundation--- - _j.-._---.Distance to nearest lot line------------------ _--_---___-_ u 2 Number of pits--------1-----------Lining material-Cid'_*:Co�gQe: Diameter------�---------------Depth-------95 F1X- Disposal Field: Distance from nearest well-----------------.Distance from foundation-------------.......Distance to nearest lot line----------------- 171 Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.-------------------- T Type of filter material-------------------------Depth of filter material-----.__----_--_-_-_--- Su__ lemen%--t°---eri- f;in Dry -nae _sY��em-- Remodeling and/or repairing (describe):-------- p .-- ------- ---••----------- -- ---------- ----- ---- ------- 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)__D A. PART{I CH & ;] ,0 '�1 SI NG; ( �� Contractor) -------------------- By�---------------•--- --------------------- Title Esti�a�or ------------------------------------------------- ----- (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 ---------------------- DATE-------------... APPLICATION ACCEPTED BY------ -------��}- � ---------- ------------ --- �`= --�--------------- f --------- -- REVIEWEDBY------------------------------------------------------- ----------------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------- --- ----------------------------- DATE----------------------------------------- -------------------- Alterations and/or recommendations--------------------------- -- -- - --------------••-------------------.-.--------------------------------------------- --------------- -------------------------------------------------------------•----------------------------------------------•---------- -- -------- PERMIT No.----- ----- ISSUED--------/— _ -------------(Date) FINAL.INSPECTION BY:--------tll) J Date------- -------------L—J ` � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639