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APPLICATION FOR SANITATION PERMIT (Co%1;fe 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--------1-1747-AG)------40jj0tr in_ T 04, *_A&------- ---- -------------------- Owner's Name----- ---- ---- 41 ----------------------------------------------------------------- Z 1 7-9 Address------------------- ------- ----------------------------------------------------------------------------------------------------------------------- -Contractor's Name__.--- '+ s ------------------------------------------ Phone-f -a 0-7---------- .Installation will serve: Residence X Apartment House F-1 Commercial F] Trailer Court F] Motel E] Other E] Number of living units: [Z Number of bedrooms 'jj- Number of baths E] Lot size__`--'- _____________________________ Water Supply: Public system S Community system E] Private E] Character of soil to a depth of 3 feet: Sand F] Gravel F] Sandy Loam E] Clay Loam E] Clay El Adobe EL Hardpan 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p blic sewer is available within 200 feet.) 'r V� Distance from nearest Septic Tank: aresf we1-WAIA------Distance from foundafion--jp---------- lvlaterial&r_�---�4 ---------------------------- 9 No. of compartments---Z------------------C a p a c i ty_'%90 j GY-------- Liquid cIepth_4_p2__'*------------ ,Cesspool: Distance from nearest well-----------------Distance from foundafion---------------------Lining material_____.____-____________--__-____-___ ❑ aterial----------------------------- ElSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line________________________________________________ Seepage ine------------------------------------------------ Seepage Pit: Distance to nearest --------Distance from foundation_40___-------Distance toAnearest login ----111�-- Number of pits----/--------------Lining material 'A��__Size- D i am efe Depth-J-47- ---------- ;4 t Disposal Field: Distance from nearest Distance from foundation__ -1............Distance to nearest lot line-----7_' Number of lines--____________---/--------------Leng�h of each line--- ............. Width of french--- -,V...................... Type of filter material-A 00r, Depth of filter material----- and/or repairing (describe):-------------------------------------- ----------------------------------------------------------------------------------------------------------------- ".j F - ------------------------------------------------------------------------ ------------IE: -Aa------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State/ ws les and regulations of the San Joaquin Local Health District. t I if (Signed} ------------ -- —----------------------------------------- ------------------(a Contractor). y:------- - --- --- ------------------------------------------------------ ----------------(Title)--- 0—-- ------------------ (Plot plans, s ing size of to ocation of s stem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- Aj- -----4_11-------—---------------------------------------------- DATE---------- ------------- REVIEWEDBY---------------------------------------------- ------------------------------- --------------------- ----------------------- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED---------------------- r-------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ----- ------- --- -- -------------------------- -- ----- ------ PERMIT -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --- � j----------------------- PERMIT No._Y__;�_O--------- ISSUED- 3 —.2-y—x1- ------------------------- ----------(Date) FINAL INSPECTION BY------------ --- ------ -------------- ----------------------- Date------------------------------- -2---- -- P------------------ JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-21A 9-50 W=1639