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411 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to cons ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. _ g L-' JOB ADDRESS AND LOCATION________________ / Owner's Name -------------------------Cap....k6o&54----- _f-------- l 90-1 Owner's -- ----------------------------------------------------- Phone------------------------------------ a Address-------------------I Q ' �? r - `Ser F Contractor's Name-------------r�--�11�--G--r'--------------------------------- ------------------------------------------------------------ Phone------------------------------------- Installation --- -- ------------------Installation will serve: Residence g Apartment House E] Commercial E] Trailer- Court E] Motel [I Other E]Number of living units: •[I] Number of bedrooms 2� Number of baths ® Lot size_______f__`__s___X____Z10�_-f_ ------------------- .a Water Supply: Public system L5 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobHardpan ❑ ' a TYPE OF,INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / r'X Septic Tank: Distance from nearest we_ll__ _-__Distance from foundation}___/_0-_____-Material________-40 No. of com artments______ -_ __ _--Capacity C� ©----Size_ 'X_9 ,,`___.____Liquid depth_____--�'_�'__'_________`__� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------- El _________--__----- _-__.______❑ Size: Diameter-- -----------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------$------------Dist ance from nearest building------------------------------------------ El Distance to nearest lot line------------ _____________________________--___- Seepage Pit: Distance to nearest well----_.`r-----------Distance from foundation___- "�� _.Distance to nearest lot line___^_��___ ❑ Number of pits____________________ _Lining material Diameter_._-__-_-___-______---_.Depth---------------------------------, Disposal Field: Dist ance.from nearest,well,-_r'----_-.Distance from foundation-----/F?-/___:.__Distance to near --�` est lot line_--__ �____ Number of lines----_______A—_____________ _ Length of each line---F0 �f 0 Width of trench-----_ _��____________..___ .• rr �---- •------- Type of filter material!_Y�'d� __Depth of filter material-------/ Remodeling and/or repairing. (describe)---------------4)_-_e_ .�----------/-1 sf 1 ! _!/ Z4"_x;4/4D -----'------------ --------------------------------------------- ---------------------- ------------------------------------ ------------------------ -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- 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 oftheSan Joaquin Local Health District. � r --------- -- ' 's-,.±1!�3_ (Signed) ---- ------------------------------------------------------- ------(Owner and/or Contractor) P By:__-------a---------------------------------------------------------------------------------------------- ------------(Title)---------------------------------------------------------------- J (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 ACCEPTED BY------------- -- --- -------------------------------------- DATE-------�[ `? f Y - REVIEWEDBY--------------------------------------------------------------------- --------- -------------------------------------------- DATE ------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------- --------------------------------------------------------- DATE Alterations and/or recommendations: --------- — ----- -- ----------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ------------ -------------------------`------------------------------- PERMIT No-trl ------- ISSUED------------------------------------------(Date) FINAL INSPECTION BY:_. / //!!/ ---------- /2C SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1b39 )