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APPLICATION FOR SANITATION PERMITY ` (Complete in Duplicate) Application is hereby made to the San Joaquin .Local HeaA 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_____ ----2202__5,_Q=ors Owner's Name........Xr- -r�f_?--- b - ' ------------------------------------------------------------------ Phone---2--0251--------------- Address 12C?2 ---By--b-amore---------------------------------------- Contractor's Name--------DQjt_a--------------------------- - - - -------------------------------------------------------- Phone------3--.3953-------- Installation will serve: Residence .M Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: •[AL Number of bedrooms umbo r of baths] Lot � sixe____g0.1__ ---------------- ------- f Public A ��-----------Water SuPPIY� s system Communitysystem [] Private F-1 W Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San dy. oa Lm E] Clay Loam E] Clay El Adobe Adobe [3 Hardpan - .1 TYPE OF INSTALLATION AND SPECIFICATIONS: � I �. (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) * ' Septic Tank: Distance from nearest well--------- Distance from I ® foundation___ _ ateriaf----- No. of compartments------2-------- iT173 G-�b _--- -------- -------- paciy-- - $0 }__------ Si esX4 _%_4r --Liquid de th__-5rr- r Cesspool: ;- - -------- from well-----------------Distance from foundation- -_____- i _ --Lining material----------"-------------_-=------ Privy: ❑ Size: Diameter--------------------------------------Depth---------------------- Privy: Distance from nearest well_______________"_____,_ ' ___Distance from nearest building --------- El Distance to nearest lot line________ =-- --- ________ ______-_____- _ t .Seepage Pit: Distance to nearest well______________________Distance from foundation_____ r � ______________.Distance to nearest lot line :____-_______ ❑ Number of pits---°------------------Lining material-----------------------Size: Diameter-----------------------.Depth------------- ---------- --- 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 motorial _ Remodeling and/or repairing (describe)--------------------- IASL. 3.1 ---tank----------- p -t,© o-ld---actibe----le-aEQ z--lie---w1th---s0-1-id-:dram r - - - - ---------- ------- -------------------------------------------------- ----------------------------------------- ------------------- 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 of the San Joaquin Local Health District. (Signed)-----------De_] ,,-;,___________ (Owner and/or Contractor) I Y:----------- Y 4faxthan------------------------------------------------ Title------Ow2aer--- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must 6e filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------------- _. _L_ ------------------------------------------- DATE---- -"�,- REVIEWED BY---------- ------- -�-�- - --- -------- --------- ---------------------------------------------------- ------------ DATE------------------------------ - -h -- ---------------------------------- ILDING PER-MIT ISSUED--------------------------- --- -- -- - ------- -- ------------------------------------ ---------- DATE-- ----- A terations and/or.recommendations_ ____ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERMIT No------------------------- ISSUED------------------------------------------ (Date) FINAL INSPECTION BY:---------L__V-14 Date 1-4'A ------------ SAN JOAQUIN_LOCAL HEALTH DISTRICT f 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California