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� F APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 473 _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_________Q4J _- /35 - tiOW-Awe-..---------------------------------------------- A 81k2� - ------------------ caner s Name-----------E1l�Y1Q__�.•`--$t1T�l�TAit81'L-- ---------- ---------- ---------- -- ------ - ----- Phone-•---- ---- -_. - ------------------ Address------- _ l°C'�iOII' ev '------------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name______ •Q�.:--P er s =_&'n_$one ?9 7—_; - -- - --------- ---- --- ----- ------------ ------•--------- Phone---.?9 --------------------- ---------------------- - ` Installation will serve: Residence X_ Apartment House ❑ Commercial ❑ Trailer Court Q Motel ❑ Other \w` 1 1 !!lVVV Number of living units: L7. 200 � 2001 ❑ Number of bedrooms Number of baths Lot size____ _______________-- -- 1 �./ ! Wafer Supply: Public system [] Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy,Loam ❑ Clay Loam [] Clay E] Adobe[T' 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___W,---- 801 �oncret - Distance froom foundation 801 jylaterial_____ _____ ___ X. No. of compartments - '----------------Ca acit - --------- --Siz = = 6=- Liquid "------- p Y e� - q 'd depth--- ----------------- -Cesspool: Distance from nearest well_________________Distance from foundation____--__"i________.Lining material______------------------------------ i ❑ Size: Diameter Depth --------------`'`- Privy: Distance from nearest well____________ ---------- -_________________ __ --_-___Distance from nearest building 9 Distance to nearest lot lineeA, ----------- _ _ _ - Seepage Pit: Distance to nearest well----------------------Distance from foundation__,--------I_------Distance to nearest lot line_____________ 1 ❑ Numbertof pits -----------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- i ?._Disposal Field: Distance from nearest well:___t__ 1_Distance from foundation.8-'°:-- _-----Distance to nearest otflin e_ 6.11___---_- Number of lines____ ----_* -__Length of each line___. 300)r� - * �. 9 --- _____-Width of trench--- Type of Filter materia!___ ------Depth of filter material-------3t__-__ ` Remodeling and/or repairing (describe):------- -------------------------------------------------------------- . - ------------------------------------ - ---------------------------- ------------------------------- ordinances, State certify is s' and rules and`regulations li th-- -- a- _that core -h --oa ui t I herebycertif chat l have prepared this application and that the work will be done in accordance with San Joaquin County e San Joaquin Local Health District. (Signed)---------Il*A. r _-&-sons-------------------------------- ----------------------------------------- _ ----------------------(d,_4VAIdr Contractor) BY:--------Qto---$GlaMba�---------------------------------------- ---------- - - --------(Title)---Eet_ X_ator- _______________ _of plans, showing size of lot, location of system in relation to wells, buildings, efc., must be Bled with this application). FORD PARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ---- -- -------------- -- ---------- DATE----- ---- I REVIEWED BY------------------------------------- --•----=-- ------. ------------------------ DATE . ------------------------------------------------PERMIT ISSUED-----------------t------- --------- - - --- ------------------- --- ---------- ----------------- DATE ----------- - Alterations and/or recommendations:___!__ - - - PERMIT No._ -a 3 ISSUED �aJ `/ v �-------__(Date) FINAL INSPECTION BY:__----__--_-- - -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT R 130 South American Street *• E$-9-2M 9-50 W-1639 Stockton, California