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APPLICATION FOR SANITATION PERMIT ,2 5 (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. I �•— � ! ��,/ ,� is s JOB ADDRESS AND L ATION--_----- _-/�.`�-------- cE--------- �------ i Owner's Name- ----- AIM---------- /-Y-- ; �---------- © ---------------------------- Phone----,/ 'r - -------------- Address-------------------------- ��` 1s� .f�->I _ 1 ��-f,/^ Contractor's Name ----------- ----------- �1 "� /r l.�_t---- Phone----�-= Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths ❑ Lot size---7'• __ -----l_S�'..------------------ Water - w-^''"___Water Supply: Public system X, Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes Hardpan'[:] TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public_sewer is available within 200 feet.) s Septic, Tank: Distance from nearest well__,7Q_____Distance from foundation__ • _______.Matenal ``� _____________________ No. of compartments_" Capacity-/--., R�. 9 p r -------------------- ----- �-- - Size�`e'-4��_=��da_�_�i uid de th_��^_._�-�__'_--•-------. Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining'material-___________-________-______________. ' ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest builclin - ❑ Distance to nearest lot line------------------------------------------------ 5ee�e Pit: Distance to nearest well____lVe________bistance from foundation_-. ___------Dista!a to nearest lot line_.,a_._______ Number of pifs__6f_Y_GJ__------Lining material_—e0d ----Size: Diameter_191,Z.-----------Depth- _"_________________ Disposal Field: Distance from nearest well---/.-0-------Distance from foundation__,.12_p--------Distance to nearest lot line__/ �.... Number of lines___/_ _ . '` : �° _______Length of each line____ __ _____ . Width of trench__- _________________-___ Type of filter material_ . X44-Depth of filter material---I,Z----------- + Remodeling and/or repairing --------- ---------- ----- r 13oy%- ~'-------------•-------- i51/! `5-------QA-------0 y_"f_a---------f4 P-------77Y92------Fif0FC✓- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, ordinances, �t fe laws, and rules and regulations of the San Joaquin Local Health District. __-__Q,_ - ~T C,_ p (Signed) �' ( Fit �� (Owner and •or Contractor) fwl;S1 By:--------------------- �i�r {Title) -�P '�{Piot plans, showing size of lot, location of system in relation touildings, etc., must be filed1th this application). FOR DEPARTMENT USE ONLY ! APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- REVIEWED BY --------------------' --------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE + Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------------------- I --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ------ PERMIT No.:/___,2Jr_ ISSUED-------- --�Y- --_- ----(Date),•FINAL INSPECTION BY:----------�Cf- ------------------ ---- ----------------- Date------------------------7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639