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APPLICATION FOR SANITATION PERMIT a. 7 p 9 (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-------. ____ - �cx� i:7-_ -/-- ----------------------------- ------------ Owner's Name--•-----------IMAX11 ---------��-L.r L — - ---- ------ ------------------------------------------------------ Phone � .P•,1 k 41 Address / fe-----------�!'�-r-------------------- Contractor's Name---.P- A � -Tl------- - - Phone--- 047------ Installation will serve: 'Residence ❑ Apartment House ❑ Commercial K Trailer Court ❑ Motel ElOther ElNumber of living units: ❑ Number of bedrooms ❑ Number of baths E] Lot size--;,14LI.-r_K_ _-----__--____- Water Supply: Public system K Community system ❑ Private ❑ x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ TYPE OF 'INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� + Septic TorLkDistance from nearest well-------------------Distance from foundation--------------------Material___---------_--__----__-__----_-------___---___ ❑ n , �� No. of compartments--------------------------Capacity-----------------------Size-------------------------------Liquid depth-------------------------- �7 Cesspoo [:��4� Distance from nearest well--------------__Distance from foundation+-------------------Lining material___--__---_---------------__------_. ❑ Size: Diameter--------------------------------------Depth------------ -------- ----------------------------- `Privy: Distance from nearest well-------------------- _--------------------Distance from nearest building-----------------------_____----_-------- El ' from fou i p Distance to nearest lot line------------------------------------------------_ - �� __-__ four -__-.Distance to nearest lot line_---�---____- . SeeRe e Pit: Distance to nearest well------.__-____ _ Distance fr, .r !� � of pits-Z)MV---------Lining material-_ YJ_ c-___Sizet.Diameter_---------------------Depth_--�/- -------------------- Number Field: Distance from nearest well___.,--_.__-.Distance from foundation-� ----------Distance to nearest lot lin -------------- Disposal �y -Number of lines----- ` -� Length"of each line__ _ -__ Width of trench__. d ________________ Type of filter material- G1Depth of filter material---- _.__ Remodelin and/or repairing describe). "41 r ------------- "- -------------------------- ------- - --------- ------------ ------------------------ -4 -----------• -- - ---------- ------------------- ' --------------- ------------------------------------------- --- --------- --- -------- ------------- ---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules an ,re lations of the San Jo uin Local Health District. - - ►�!----------{Owner nd r Co actor I (Signed)------ f BY' j { -------- -` ---------------------------------(rifle) .. . --- - --- - ------ --------- -- ---- - --- (Plot plans, showing size of lot, location of system in la ion to wells, buildings, efc., must be filed With this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------------------ DATE----- ------------------------------------------ REVIEWED BY DATE-------- _:;�; PERMITISSUED------------- -------------------------------------------------------- ------ DATE-------------%------------------------------------------ Alterations --------------- ----------------------Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------------`-- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- . F - ------------------------------ -------------------- ----------- --------- ------------------------------------------------------------- -------- ----- ----------------------- i ----'1 {Date) FINAL INSPECTION BY •f �� "'-- PEtI�Thf No,'--- ISSUED------- / l _ / Date----------l---- ------------ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639