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`rd APPLICATION FOR SANITATION PERMIT Permit No. )Complete in Duplicate) 3� Data Issued ..._...}1A-2 q i 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 w:fh County Ordinance N'o`549. JOB ADDRESS AND CATIO _�.Q .. ...-�Q.... ..-Id.! . . 4.9- Owner's eme........... .. ... ... ......... one - ^^ ! � ` Ph Addresr.....y..�_.A._..._........ ..B�LQA ... :.. t>Zr�... .. _..................._............ l.. Contractor's Neme..- ....21.......�.k/.C................ ...... . ............................. Phon ..�.'�.�.� ...6._ Installation will terve: Residence ❑ Apartment House ❑ Commercie�f,/---Trailer Court ❑ M*I ❑ Other ❑ " ....... f/JJ�.,, Number of living units:........ Number of bedrooms ........ Number o aths ........ Lot size EG .......................... Wafer Supply: Public system ❑ Com nify system ❑ Private Depth to Water Table!'.tB ft. Character of soil to a depth of 3 fee Send ❑ Grayel❑ Sandy Loam❑ Clay Loam❑ Clay❑ 'Adobe \ l Hardpan❑ Previous Application Made: Yes No ❑ Now Construction: Yes ❑ No 0�A/VA:Yes❑ No f}. TYPE OF INSTALLATION AND SPECIFICATIONS: _ l No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tan : \ Distance from nearest well.................Distance from foundation....... ............Material..........................................._... No. of compartments.........................Size............................._.Liquid depth.........................Capacity..._................. sal �d: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line............ Number of lines...................................Length of each line............................Width of french................................... Type of filter material............. Depth of filter material.......................Total length..........._.._......................... II Seeps a Pit: Distenre to nearest walla ...♦........Distance ro foundetion.Jl40...._._Di tante to nearest lot Iine..1 _._ Number os P;fs...,2.............Lining material.. .........Size: Diameter.... s8 Q. "....Depth..R.S................._ O Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..................... .._............ Cl Size: Diarneter.............._. _. ...............Depth...................................................Liquid Capacity.......................... Privy: Distance 'From nearest yell...... .. . . . ..._....Distance211" nearest building �s Distance to nearest lot line.. .. .... .._ _...___. __.. ............ ...._..... _ ....Remodeling and/or repairing )describe): .... ay.,__,.. „......... ... .._..........................._._.............._......................... . ............................................. ..............._..........................................................................................................—..... ..................................._........___...........__........... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances State laws, and rules and regulations of the San Joaquin Local Health District. )Signed),�R.F_4-11lGHT.__�e-phC �S...53j.V(sL ......................._— _...fie'Contractor) By:......-.....__..-.................-...__.....................---...._................_. ... )Title).._..........._....................._..._ __............. vl )Plot plan, showing size of lot, location of system in relation 4o W;buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....(a y!.`.... .. ... ..... . .. . . . .. ...... .._._............................... DATE........:.-.... ...L.'.::'Y................ ......... REVIEWEDBY.............................. .. ...... . ,_. ........ .._. _. _._ _._ _. ... . .............. DATE........—......_........... .............................. BUILDING PERMIT ISSUED. _....__.__............... ......__......__........._................................... DATE._.......................... ................._........_.. Alterations and/or recommendations:... ....... ................. . . .............. .. 1:7.._..... V -Y..f..t) rel`:P..E.. ...1.t!.I�{....._t.J.:[r.f_................. ... l.:t. .......... .. .......... ...... .............. . .................. . _..... _ .. / .. ... ... ..............._. ............_ /� .......... FIN-AL INSPECifOI"YJ_-�`�C�t”-�L 13 .�.� -c.b�.,, r , Date.. . SAN JOAQUIN LOCAL HEALTH DISTRICT 120 South Amerieen S1ruf A'0 Wed Oak Sfnaf 172 Syu:nore Sfiset BN North "C"Sir.# Stockton, C.I;W.ie ked;, C.130,.L Menbu, Gl:fernia Tray, California ES-9-2M Reviwa 1-52 rPCO.