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3 APPLICATION FOR SANITATION PERMIT j 0 (Complete in Duplicate) 1 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------FiSlr--poton__of__ own_TrCt--off_Hi7.clrethane----------------------------------------------- Owner's Name----------------------------------------T' E.. Mlliamson-, Inc. ` '------------- Phone-------9-9073"------------- Address---------u � _Bro __ xaCt__ _ dust_paa� _C.G.Q.--Rte,--line ark right side-- ----of_f Hilt eth Lanes-____-- Contractor's Name vxrjah__&_Sono-j--!nA ----------------9---------------o----------•Phone--------9--96-W------------- Installation will serve: Residence .�Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [1. Number of bedrooms [3: Number of baths Q" Lot size-1Z- 5!X931--MUMS------------------"---- Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe]` Hardpan ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i t Septic Tank: Distance from nearest well______X30 t____Dissance from foundation__12_________P:Material---G__ir'i---RA ------------------------ Ir No. of compartments-------- _---------------Capacity-12()4__CA _Size___776"2456TM__Liquid depth_______60----------- i -Cesspool: Distance from nearest well--- "----------Distance from foundation--------------------Lining material_________________________________-_. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest builcling----------------------------------------- El Distance to nearest lot line------------------------------------------------ Seepage ______________________________________________Seepage Pit: Distance to nearest well _1351Distance from foundation-----7.Q0;___.Distance to-nearest lot line"_- 101_____ [ Number,of pits--------I-----------Lining material___GC__R'i_0);Size: Diameter_______ ___-" _-Depth-------l0t------------------- t,.Disposal Field: ' : ;'-Distance from nearest wefl___7O1"-----Distance from foundation____l5t-------Distance to nearest lot line-----IZ!----- [g Number of lines-----`-.------x-------------------Length of each line--------75-1---------------Width of trench------7.1!--------_------------ Type of filter material____-- ----Rk___Depth of filter material----------- -Remodeling ____-__--Z-Remodeling and/or repairing (describe)--------------New:_�.nstallati01�____sa------------------------------------------------------------------------------------------ -----------------------------•-------"--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------"------- ------------------------------------------------------------------------------------ ---------------------------------------------- -- -- i ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepa"red 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)--- D A.bP TSH-&-SONS.. INCA ------------( Contractor) _ ----- ------- ---- ------ i _ (Title)------330timator--------------- ------------------ (Plot plans, sh ing size of lot, location , ystem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- ------ ------------------- ---------- —---------------------------------- DATE------------------------------------------------------------ REVIEWED BY---------------------------------------- -------- --------------------------------------------- DATE- -/_ �^_ --- - 4' BUILDING PERMIT ISSUED - . --- - r'V - DATE - ------------- -- -------------- Alterationsand/or recommendations------------------------------------------------"------------------------------------------------------------------------------ ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- �e PERMIT No/+O_G _ _- ISSUED------ _ �'-----(Date) FINAL INSPECTION BY:"____-_—W. ___".____`___________________________ Date------------------- ✓_----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ► ES-9-2M 9-50 W-1639