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F,F APPLICATION FOR SANITATION PERMIT I (Complete in Duplicate) `� Date Issued `S 5'3 Apication is hereby made to the San Joaquin Local Health District for a permit to construct and install-the-work-lierein described. . This application is made in compliance with County Ordinance No 549. JOB ADDRESS AND kQCATION----._____ __ .. --------------------------- �A7,3 Owner's Name �� -- ---•---- -- . Phone-- --- hone - Address. _. 4-_' ----•--------- -- --- ------ - - -----•-••-----•-----...-----•. ------------------- .....---•---------------------------•- ----•---- /"� pp qq�� 7 Contractor's Name---- ---- - r------t/------------ ---- --------------- --� � Phone..L_-"Rl_�Q-7- Installation will serve: r Residence W--�Apartment House ❑ Commercial ❑ Trailer Curt L] Motel ❑/ Other ❑ Number of living units: __./--- Nuate mber of bedrooms __ - Number of baths .---!_. Lot.size . ___E*___/- Q----•------------------------ Water Supply: Public system Rr"'Community system ❑ Private ❑ Depth to Water Table _Ye.ft. Character of soil to adepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Adobe Hardpan ❑ n Previous Application Made: Yes 2"No ❑ New Construction: Yes UR--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan�or cesspool permitted if publicpewer is available within 200 feet.) w o �. Septic T nk: Distance from nearest well-��7Q------Distanc% from foundation----- Material----------------------------p__ _____.____ _. l Il No.°of compartments----------sz�_-.__- ---Size-��__x� __ - .---Liquid depth--- --------------Capacity..I-- 0 -- I it 1 Disposal Field: Distance from nearest well d__...Distance from foundation___��----_---.Distance to nearest lot line.............. Number of lines------------ a� [ Length of each line----__010----oo--�-----.Width of trench-------- -- --_L_-- - .x Type of filter materiall _.W1P:�__..._De th�of filter materialk_S.Asi!l4_--..f g p ._Total length ��--__- ,ogk-r, Seepage,Pit: Distance to nearest wl!___. :_-_ Distance from foundation Diamete Distance to nearest lot line--- ._�;- w 4 e ,r [ Number of pits-------- Lining material Ca it fr Q� Depth----- i Cesspool: Distance from nearest well-----------------Distance from fou n ation---.-_---___!__ :oLining material------------------- ----------------- ❑ Size: Diameter--�---------------------------- -------bepth_A� ��------------- ------- - Liquid Capacity gals. Privy:' Distance from nearest well-_______-.__-----. Distance from nearest building �';�, ❑ •.;)','eta , '"� - ---------------------•- --------------- �4Distance to nearest lot line ---------------- A ----- ------ A Remodeling and/or 1pairing (describe): "` ; f - -----------------,, !, _ ---•-•-------•-------•--•---------•-----------------'-------------------------------------•------------------------------- ef ------------ f ------------------------------------------------------- ------------------------ --------------- -- --- - ---- ----------------------------- I hereby certify that I have prepared Ws"'application and tharfKe- d-rrk will"be done.in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. r i �T _ _ . - -------- -------------A-- ------------- ----- ( ►rrer and/or Contractor) (Signed) =- - or - By------------- Title " -------- ------ {Plot plan, showing sizie of lot, location of'system in relation to wells, buildings';,etch, can be placed on reverse side]. � 4 TFOR DE 3.TM ENT USE ONLY APPLICATION ACCEPTED BY--- ------i------- --------- -----------•---------------- DATE! REVIEWEDBY------------------------------- -----I--- --------------------------------- ------ DATE BUILDING PERMIT ISSUEQ______________ _ DATE__.__.-.- - --------------------- --------- -------- ------------------------ ----------------- i --------------------- -------------------• -------------------------------------------- Alterations and/or recommends#ions--------------------------_...__-__-_---_--_-:_.________________- ----------------------- ------------------------------ -----------------------I------------------------- ---------------.....---------------------- ---------- ----------------------------•--i--------------------•-------------------------------------------•--- f `- --------"------------------..--------------------------.---------- _-...--------'---------------------- -----------------•-------------------------------------------------------------------- I- _-------__..-- --- --.. ` -----' '---------- ------------------------------• ----_ -------- ----------- -------------------------------- FINAL INSPECTION 81 :.. =----- •----- Date-------- � -- - - --------------------- t SAN-JOAQUIN-LOCAL,HEA TH.,DISTRICT- -- 130 South`American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street b" Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100