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7`7 I Perini# No. ----{�-1----6----- w APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued_'- -.------ Appl'rca�ion is hereby maria 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. O ------------------------------------------- 7 ------------•-----•---------•-- -- JOB ADDRESS AND LOCATION.. i . + Phone--- ------------- Owners Name--------------------- ----------------- ------ I _ .4! -" -"-------------------------------------------------------------------------------------------- Address.-.-----•--------•------•-- -•--- 5` ` -a_c A' fi �/' - ----- Phone-------- ---- f r __:._. ... Contractor's Name------- - --•---------- Installation will serve: Resit ante Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ ff s- .. _ -- ------------------ " .. Number of baths ._.L... Lot.size ..-.. Number of living un-its: -.-I._- Number of bedrooms". Water Supply: Public sys �m ❑ Community system ❑ tPri�ate Depth to Wafter Table _��---- ft. . Character of soil to a deptHardpan h of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application Madre: Yes F-1No New Construction: Yes �o El - TYPE OF INSTALLATION AND SPECIFICATIONS: (I� ' (No septic tank or IcIesspool permitted if public sewer is available within 2�U feet; Septic Tank: DistanCle from nearest viell:°� --.--Distance from foundation._/d.....-.____.Mafieri�al..- �_a_c_i�y -- - -------- - --------- - Size-- XXL ---Liquid depth".3 -- _ {Q No. o�;l compartments..----- T Disposal Field: Distance from nearest wei}�0_o Distance from foundati n.l-------------_.Distance to nearest lot !i `s_ I U - :Len th of each line --------- Width of trench. Numb�e' or Ines _ g „ ------------------------- Type �i filter mate .._.._.Depth of filter material_../�_________ Total length._-...� Seepage Pit: Distar�lCe to nearest we ----------------- Distance from foundation....................Distance to nearest lot line-_.. Num�`r of pits ------ ------Lining material-----------------------Size: Diameter------------ Num Depth 111 . ing material Cesspool: Distance from nearest well...__..--------Distance from foundation-_----- Liquid Capacity-: gals. Depth- - q P Y, ❑ Size:.. iameter---------------------------- -------- Distance from nearest building----------------------------------- ----• Privy: Dista�pce from nearest well------------------ ------ ---------- El Distance to nearest lot line-------- - +y _ --------- and/or repair� ing (describe):--(- Remodeling ----- ----------•---------- ------------------•---•------•---••---•-----•--------•-----------------------------------------••------------------•------------- �� ----------------------••------------•---_----------------•-- �+ I�� \ - ---•--------=-----•-----••--•--------••-------- -------------------•---------------•• -------•--------- - ----•--- 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, ahnd rules and regulations of the San Joaquin Local Health District. i (Signed). 0�44 �` , -(Owner and/or Contractor( I ------------------------------------------------------- --------- - Title BY:- ------- I ... (Plot plan, showing size 4f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. �II FOR DEPARTMENT USE ONLY ---- -------- ---- DATE .� 1. ----- -- ----- ----------- APPLICATION ACCEPTED BY------------------------ , I` DATE. ------------------------------------ REVIEWED BY-------------------------------- ---------- -----: ------- --------- �-"-' ----- --------- DATE.---- ------------------------------------------------------- BUILDING •---------------------- --------- -------•---...---- BUILDING PERMIT ISS 1 ED------------------------r--------------------------------------------- ----- ----------- ---"----------•---------------------....---•-------------------------- Alterations and/or recommendations:-.-.---.J�..;a�- -- 0----------•------ - ------------------------------=-- -------------------------•----------•--- -------------------------------------------------------- ------... ------- -•----------------- •-- ------------- I I ---------------------------------- ------ ---------••---------- � � µ ------- ------ FINAL INSPECTION BY:.- --------------- ---------------- ---= ---- - Date....'-•�""�---�- "---�--� SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street [30 South American Street Trac California Stockton, California Lodi , California "Alanteca, California Y. £5-9-2M 145446 A�WDOO I i 12-54 _ - -