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jL-.3 h APPLICATION FOR SANITATION PERMIT (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-----1Q11--3a......5ha_s't a------------------------------------------------------------------------------------------------------------- Owner's Name---Hr_.____and__X3?a........G-e1.-e__1iay_e-'--------------------------------------------------------------------------------- Phone_-1'6_589----------------- Address--------1-411---Sa-.---Sh-az -a----------------------------------------------------- -- ----------- --------------------------------------- -- ------------------------------------------------ Contractor's Name.... Zt,2-_Sntc...Tank--Service. 3-3955 ---- -- - -- - ----- ---------------------------------------- Phone----------- - - -------------- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ® Number of bedrooms ® Number of baths [U Lot size------ __________________________ l Water Supply: Public system [3 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ O t 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....------------------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 _______________________________________________ Seeps a Pit: Distance to pits-. well________________g Distance from foundation--------------------Distance to nearest lot line-________-___-__- p g - ---- Number of its_.•..__Z__-_________Linin material__br—tak------Size: Diameter........4 ___._...Depth_ i►;Lr_ ,�i _ Dispos I Field: Distance from nearest well______`_"~�___Distance from foundation-----Z6_7__Distance to nearest lot line---16---_-__ t Number of lines--------------_ __�_______. Length of each line------I�__ ______ Width of french__--__--_- _ _- _-------- Type of filter material______ _____ Depth of filter material_____________��- Remodeling and/or repairing (describe):________s'e—p�_i?l ___a1cL__1e$CY1__ c�_ L_—••__w-2---yet_i11---�1i.lmp--t-he---Selat_ic t_.r.3�_��rhj_ch._hnlda---at---le s $QQ--_ at.---------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules and ulations the San Joaquin Local Health District. (Si nsd 9 } - ----- ----- ---------------------------------------------------------------------------• ------------(Owner and/or Contractor) By:__ -e-115i-W_aTllisn----------------------------------------------------------------------------------------(Title)------pWri_er-�N ---_--------------------------- �(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------- %70- -,Z)' c—I -------------------- DATE---------AP 2 5 � `'3---------------- REVIEWED BY--------------------------- ' L ---------- DATE------------l6' ``TO--------- --------------------------- -------------------------------------------------- - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------------- ------------------------------- Alterations and/or recommendations___________________________________ _d� ------------------------------ -------------------------------- ------- ,::�. -------------- .. ----------- ------------------------- ----------------------- -- -------- --- - ----------- - ----------- ------------ PERMIT No--------63------- ISSUED----�_a_ _ -4' _.S`_�--------- Date) FIN L INSPECTION Date---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1.30 South American Street Stockton, California ES-9-2M 9-50 W=1639