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f , 4. APPLICATION FOR SANITATION PERMIT �+ (Complete in Duplicate) f . 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________'_F �..� K L - 42j Owner's Name c Z-. D1 01 L1 —- F (, Address_ ---;�O X---42 4_ --------------------------------------------------------------------- ontractor's Name ----- ------------------- Phone_ -3955-- Installation will serve: Residence ff Apartment House E] Commercial [] Trailer Court ❑ Motel ❑ Other ❑ A 1 Number of living units: •[], Number of bedrooms Ej- Number of baths ® Lot size---------I- Water Supply: t Public system ❑ Communitysystem y stem ❑ Private � Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL__'Qt______Distance from foundation Qs-_ Material_____.__reCZ-F7QL _---___ __ No. of compartments 2 Capacity '------------Size-------------:5-'2�a-------LiquiO depth Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material__________.___--_______-_ 1,. ❑ Size: Diameter--------------------------------------Depth---------- ------------ r Privy: Distance from nearest well____________________---_--_--- Distance from nearest building , ❑ Distance to nearest lot line-_______________._ --------- ----------------------------- Seepage Pit: Distance to nearest well--------'75,!__-___Distance from foundation______-----------.Distance to nearest lot line-----2._------- + ZNumber of pits-----__1-----------Lining material[___----b z_lak_-Size: Diameter-----------3 t__---_-Depth------.25------------------ N-- Disposal Field: Distance from nearest well------5Q'--_Distance from foundation_____ 3-Q1------_Distance to nearest lottline____2_:.____-� r EX 'i�?tr' Number of 2' Number --Length of each line----� --------------------Width of trench--------2--------------- ------- Type of filter material___-Y'O-C __-Depth of filter Remodeling and/or repairing (describe)----------------r—e-pair-' r- ins_tajj rj_c, - '- -Uo---toept-1-a---tMl ---Ifit-1-=1- .orIZabital__dr-ain------(ZaUd - ----------------------------------------------------------------------------- ----------------------------------------- ------------------------------------- . - --------------------------------------------- I hereby certify that I have prepared 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. _: DiaJ. a=_ =-'== ---- --- _-_---- ------ - (Owner and/or Contractor) BY P rr ------'��Y't a--------------------------------------- - ---------------------- - - -- (Title) 0 �1er--ItlT - T - ---------------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- ----f ___ --------------- ----- -------------------------------- DATE--- REVIEWED BY 6 BUILDING PERMIT ISSUED - - ---------- -- DATE------------ -------------------------------------------- -- --------------- ------ ---------- ---- -------- - - Alterations and/or recommendations:- _ --------- DATE------------------------------------------------------------- ------------------------------------------ i _____-___--_�--_----- ---- ---------------------- ----------------------------------------------------------------------------------- - ----------- -------------------------------------------------------------- --------------------------- ----------------------------- ------------------- _ PERMIT No.-- - -- ISSUED-__- a- -_______--(Date) FINAL INSPECTION BY:_____ -- -------- Date--------------- I ----£ ----- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California { >s ES-9-2M 9-50 W=1639 � i