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APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) { R 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. cZ J j ,� Ok�6I11 .�� stn?V JOB ADDRESS AN LOCATION_;. -- ------------------ f j H-C-'----MV-----�/[fi _�, /1 / -_. ------- Owner's _Owner's Name---- ----Ak' kZ1----------- ---------------- ----------- -------- -- --------------- ��. Phone --"" Address---- - -------le© •------------------- ----• -�--s--- � [[ ----------------------------------------------- Contractor's Name--------- -----------fl�__R R-(- ` CL -----C'� vs9A1_ ..� f �—C-t------- Phone--��_f'�__7----- Installation will serve: Residence Apartment House E]' Commercial E] Trailer Court E] Motel ❑ Other Eld�j ' •ff Number of living units: Number of bedrooms Number of baths x Lot size!-4e�---Xl _-- Water Supply: Public system [❑ Community system ❑ Privatex Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe 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 wefi__ �----Distance from foundation---/.Z-------------M-_aterial___q _af,rowgr� No. of com artments_�v1f depthj ----- -_-_- ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________________________ - ❑ Size: Diameter--------------------------------------Depth------------------------------------------------ - 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------__------------ ---------- ❑ Distance to nearest'lof line________________________________________________ Seepage Pif:` Distance to•nearesf well----------------------Distance from foundation--?_______________.Disfance to nearest lot line-_________--- --_ ❑ Number of pits----------------------Lining material-----------------------Size_.Diameter--_-----------------_--Depth---,--:--=- _•---:-------- Dispas�l Field: Distance from nearest well DO _____.Distance from foundation � __-____-_-Qistance to nearest lot line___________ Number of lines___ ' --_ -----_-_Length of each line___�+'��_= Width of trench--10/_ _!/---------------- ,,,,,�� j r ;r Type of filter maferial// _&A Length of filter material_. -------- -Remodeling _____Remodeling and/or repairing (describe):--- - ------------ -- - ------- ---------------------------4 --------------------------------------------------------•-----_ �► = ------------------------------------------------------------------------------f---- -- - ---------------------------------------------------------I----------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 f law, and rul s nd regulations the;San aquin Local Health District. (Signed).. ` 4 ; s_/_�.__ el�affion - �3 � � --- OwnerEan or Co tractori ) •By--- ------------- -f---- rTitle __ ---- ---- ------ -----------------{Plot plans, s owing siie of lot, location of system in to wells, b dings, etc., must be fried rt�h }his application). Pp .) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------------------;-----r-��------------------------:------- DATE---- 4 = REVIEWEDBY ------- ----------- ---- ------- ------------------------------------------------------------ ------- DATE----------�=-- ---------------------------------------- BUILDING PERMIT ISSUED------------- -------------------------------------------------`---------------------- DATE----------- %4 ------ aerations and/or recommendations------------------------------------------------ s --------------------•------------ ----•-------------------------------------------- ----------------------•-------------------------------------------------------•-- -------------------------------------------------------------------------------- --------------------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------- ------ I----- I -0--- - --- --------------------- -------- - - ------------------------------------------- ------------------ -------------------------------- PERMIT No.__��_ _ ____ _ ISSUED___________ ___ •!<_ ----------- FINAL INSPECTION BY/---- JJ _ -------------- i Date--------- �. SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 5-4-2M 9-50 W-1634 Stockton, California t