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V 4k 10700 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_,pLuW---1A .1�r• �![� ------aJ . e1 ifs.s--------------------------------------------- - Owner's Name--------------------------------- � �-- �-Sr ----------------------------------V---------------------------------------------- Phone-49f ------------- Address ----------- Address-----1----------- yp � ts axe --_--------------------------------------------- ----------------------------------------- Contractor s Name------------------- �'� 4 til �i R @.1sr[ .---� Phone r` �Q Installation will serve: ResidenceW Apartment House ❑ Commercial ❑ Trailer Court ZI Motel ❑ Other ❑ Number of living units: Z Number of bedrooms JyNumber.of baths I Lot size_/_6 4-9---___'____________________________.___ Water Supply: Public system ❑ Community system ❑ Private Dr i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ AdobeX 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 wells'-©------- Distance fr m foundation_/______ _ ___#___.Material----- _ ___ '> .......... No. of compartments-------.�+______________Capacity_+ QV------------Siz�K X_4?*_Liquid depth-�;2__�--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1-1 Size: Diameter--------------------------------------Depth---------------------------------------------------- .Privy: Distance from nearest well-------------------------------------------------Distance from nearest-building_____________.__________________________-. ❑ Distance to nearest lot line------------------------------------------------ .001' _ _-------______-_i Seepage Pit: Distance to nearest well_ /9?0--------Distance ir ffo ndation-'�Q ______-Distn e to nearest lot 1n�_ - _ ,K Number of pits______----------__Lining materia ___Size: Diameter_"___________,.Depth__,r2____________------- jr 000 Disposal Field: Distance from nearest well-Ac '-----.Distance from foundation_�____-------Distance to nearest lot line_________________ Number of lines------- Length of each line_,____ --------------Width of french------4 f�-_!___________ Type of filter material_________________________Depth of filter material-_______-__.___-_______ -Remodeling and/or repairing (describe):-----------------plaw-----IrwS-76a��/� ----------- -------------------------------------------------------------------------------------------------------------•------------------------------------- ------------------------------------------------------------------------- ------------------------ ---------------------------------t-----------------------------------------------.---- ------------- --------------------------------------------------------------•-------- ---- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that'the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regu tions of the San Joaquin Local Health District. /f4(Signed).... s �` ----------- ----------------------------------------------------------------( r Contractor) By: .- • - 4 (Ti+le4e�d%with � �--------------------- (Plot -- (Plot p1 s, ' e of lot, location of stem in relation to wells, buildings, etc., must be this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------•-------------- -------------------------------- --------------------------- DATE- Jct. - REVIEWEDBY *' - ------------------------------------------- ----------=------------------ DATE ----------•-------- -- ---------------- BUILDING PERMIT ISSUED----- DATE Alterati ns and/or re ommendations:� :---- ----- ------------------ ----- ------------ ---------------------------------- ---------------------------------- - �-- �- --------- ---------- ------ ---- ---------- ---------- -- --- --- -------------------- ------ ----- - ------------------------------ --- -------------------------------------------------- �------- ----------------------------------------------------------------------------------- ------------------ ------------------------------------------------------------------------- -------------------------- -- de PERMIT Ng/__'_!)__,Z_c ----- ISSUED-----___ _SJ _7*_0_'____(Date) FINAL INSPECTION BY:--------- ------1l--------------------------- Date---------------------- S J-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9----2M 9-50 W-1639