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a PPL.ICATION FOR SANITATION PERMIT (Complete in Duplicate) + 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall'the work herein described.-4 This application is made in compliance with County Ordinance Na:',549. I f r JOB ADDRESS AND LOCATION-----l-_R> _ (-f `= •f�l(.r' ------------------------------------------------ Owner's Name ;. -,t __s __ ---------------------------------------------------------- - -------------------------- --------- Phone----------------------------------- Address------ / --- -- ------------- - ---------------------------------------------------------- -------------------------------- r/-_ 57 / 12 Contractor's Name---- n.1x a. i Rt= ^/J I?sa'. ------------------------------------ Phone---:--------- - Anstallation will serve: Residence)d Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !Q 7 Number of living units: [� Number of bedrooms Number of baths ❑ Lot size____c-._________ -_� ______ _ ----------------------- Water Supply: Public system'0l, Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan TYPE -OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted3 if public sewer is available within 240 feet.) i Septic Tank: Distance from nearest well___'—'_Distance from foundation------ :dr __-----------------/-------------. 1 No, of compartments_______ -------------Ca aci 9/t q-----__Size_._ __�+`_: - ____Liquid d _ epth �� ___-__.____-__ Cesspool: Distance from nearest well:______z---------Distance from foundation--------------------Lining material-_______---______________-________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------._______._-----. Distance to nearest lot kine------------------------------------------------ Seepage _____________________________________________ _Seepage Pit: Distance to nearest well-------------------- ----Distance from foundation___2_ ----__.Dis#ante to nearest lot line___S -; Number of pits--------/-----_-----Lining material___(,'__&_'• _Size: Diameter------ft7? --------Depth--.49.0-__f_____-_-____-__ -Disposal Field: Distance from nearest well_+^ ---_.Disfance from foundation____---------_Distance to nearest lot line--._P--------- Number of lines____________Ypp_ ________________Length of each line---------4_ __'----------Width of trench-___ 3f_'_______________ Type of filter material__1r�___ �C_____De `th of filter material______�R _._____ `Remodeling and/or repairing (dlscribe):----------------------------- lv'�/Ff�t-flan -------------------------------------------------•-------------- ----------------- -------- -------------------------------------------------------------------------------------------- Tti - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that +he 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)-- �F] "!_._. Q�IJI/t ,--'�-- -----S---t_4 --------------------------------------------------- _ Owner�a[d/or Contractor] B . _ --------------------------------- (Plot - �T t- ----------- ------------------------------------(Title)-_--- 4-= .e_ r 2.-------- Y' z-.-- -------- - (Plot plans, showing size of lot, location of system in rela+ionto wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------- S�---------•------------------------------------ DATE------------ - -----,-, ---- • - --------- REVIEWEDBY----------------------------------------------------------- ---------------- --------------- --------------- - DATE------------ ✓ ---- BUILDINGPERMIT ISSUED------------------------------ --------------------------------------------------------------------- DATE. Alterationsand/or recommenda+ions------------------------------------------- -------------------------------------------------------------------------------------------------------------- r -- (�-- -------- - ------------------------------------------------ V - - - -- ---------------------------------------------------- p-- -------•------------------- _____�_________-____(Dater FINAL INSPECTION BY:------ -"�.---f-T/---- }' ----------------------------------- PERMIT No.---S=�--,.>-�--�.. ISSUED - - ---� Date-------------- --------- -------------- t---�i-,----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639