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APPLICATION FOR SANITATION PERMIT r (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. JOB ADDRESS AND LOCATION------------ 01+4--Funst an___Ave�___St acllt on___________________ _ -------------------------------------------------------- Owner's Name-----------------Edw - d---G_.____Grad-y----------------------------------------------------- --- Phone---4!n7_ LU--------------- Address-------------------------------20.44---Funa-.nn_... ---------------------------------------------------------------------------------------------------- Contractor's Name......D..__.A,-__ kR Tl.._ _ S01,�T ITC_ Phone-------9-- _6Q_7__--.______ Installation will serve: Residence [3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑, Number of bedrooms EX Number of baths ❑l Lot size------- k-----111_____________ Water Supply: Public system KI Community system ❑ Private ❑ t W " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay ❑ Adobe [a 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-----------------------S€ze----..-•-----------------------Liquid depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material.__--_------------__-----------_____-. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Y Priv Distance from nearest well----------------- ---Distance from nearest building ; ❑ Distance to nearest lot line------------------------------------------------- Seepage Pit: Distance to nearest well from foundation______ 3Q1------Distance to nearest lot line_---- ® Number of pits--------!-----------Lining material c Q_110_-BlXize: Diameter--------33."____---.Depth---------2 1_-____-----_--_ Disposal Field: Distance from nearest well--_-------------.Distance from foundation--------------------Distance to nearest lot line________.- ❑ Number of lines-----------_----------------------Length of each line-_.----------------.----------Width of trench-----_---- _--_------ Type of filter material-------------------------Depth of filter materia l-- --------------------- n`9 describe):__________Supplerie7 to GXisin draire. e s Remodeling and/or rePain --------- ,_----_-`---g------.----- - vm ' -----------------------------------------------------------------------------------------------•---------------------------------------------------------------- ---------.-------.._..--------......------------------- ---------------------------------------------------------------------------------------- -------------------------------------------- -----------------------------------------------------------------------•---------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan S% laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- --,9- - 'U Contractor) ---------•--------.----------r-------------- -----r-----------( �� ) By:--- ---- - '------------- -------- - -----, ---------------------------------------(Title)-------ESt ma-t-ar----------------------------- (Plot pla s, sho thgsize of lot, location of system i elation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ------ DATE----- REVIEWEDBY------------------------------------ ----------------------------------------- ----------------------------------------------- DATE-------- --------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------- ------------------------------------ Alterations and/or recommendations-------------------------------------------------------------------------- ----------- ----------------------- ------------------------------------------------------------------------------------------------------------------_.-...--------------------------------------------=------------------------ ------------------------------------------------------------------------------------------------------------------""------------- -------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No._c,"-__ --------- ISSUED---------- _-- -=-—------------(Date) FINAL INSPECTION BY:--------------- Date------------------ - f -". f----------------------------------- 19 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639