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APPLICATION FOR SANITATION PERMIT Permit'No. .__7_- -- -_!,-___ (Complete in Duplicate) Date Issued ?!/ -f Applica{ion is he 1�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 I AND CATION_________ - . ----- - " ---4------- ------------------------------------------�i------------------------------- Owner's Name--- ` ------- ---- ----- ------------.". Phone---I( Address-.--------------- N -------------------------------------------------- - Contractor's Name -------- -- -------------------------- Phone----. hone-- --------- --------------------------------- �. Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ M&eI ❑ Other ❑ Number of living units: __-- Number of bedrooms-3---- Number of baths _�)-r�-Lot size ------- Water __-Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ___"____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Ldam ❑ Clay Loam [D Clay ❑ Adobe` ' Hardpan ❑ Previous Application Made: Yes E] Na Z New Construction: Yes' o El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptTank: * Distance from nearest well.�s. _."._Distance from foundation__ _ Material_" - '------------ o. o compartments-- -- -------------Size--�---Y �k_, ------Liquid depth- — ---------Capi�cify-- Q Disposal Field: Distance from nearest weft...< _ 1 j _.".- ._Distance from foundation-�---.--__".-.Distance to nearest lot line.___ Number of lines---"---- -----------L-j-_-_- 9th�f each line---'---�p-- '---- .... .Width of trench--- -- ---- Type of filter materia--- {_cam �----- � ter material length-----L-�--`�---------•------- Seepage Pit: Distance to nearest well.---"."._-_.._-_-----Distance from foundation____________________Distance to nearest lot line_______.______.__ ❑ Number of pits------------- --------Lining material------------------- Size: Diameter Depth-1" - ---------- Cesspool: Distance from nearest well-----------------Distance from foundation___ --_._-.___.Lining material__---.-II--""--""__-----_-----_- " ❑ Size: Diameter-------- --- ---.Depth---- --------------- -------------- ------ --Liquid Capacity --:I--------- --gals. -------- ❑ ---- Privy: Distance from nearest well-------------__________"_____.____"_._______.-Distance from nearest building--------------------------------------- _ Distance to nearest lot line----------------------------•:---- :IM Remodeling and/or repairing (describe):------------------------------------------------------------ -------- ii •--------------------------- -----------------I-------------------------------------------------•------------------- -'-------------------------- ` ----------------------- --------------------------------------------------•--------------------------------------------------------------- ----------------- -----------------------•-- !I----------------------------- E I hereby certify that I have prepared this application and that the work wilt be done in accordance with San'Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Si ned E 9 )---------------••--------------•--------; -=------ (Owner and/or Contractor) ) By:----•-------------------------------------------------------------------------------- ----------------•---------------------------- Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed-on reverse side). FOR DEPARTMENT U ' SE ONLY - .II. APPLICATION ACCEPTED BY -------------------------------------------------------------- DATE---------- -------------------- REVIEWED BY _ ". r.� -- - - ----"----------------------------------------------- ---------- DATE---------------�-• ---.- IM- ----- -` ----------- DATE._- ------ ----------�" / ._ Alterations and/or recommendations'----- ----- ----- ----- ---••---•--------------------- ------ ---- ------------ U1LDlNG PERMIT ISSUED.-,----------------------- a _ " I ----- ... ------- ------- ---------------------------------- ---- ;�F---- ----------_-------- 7 3 :e-------�j--------�c'� rz_�-----= " ate 7P_ 'z -------� O.U.r�----- ' ` ------------------------------------------------.. 4t4�erS -PP04 y-------e_!cz�_"._.!�"�C4= ..... 'at --:dpi. -•------------------------------ ----- - ... 'n� �1c="�J--------- ----•- c.)C-,.7 c.r?/z=7Z A77-k7%IIA',07" /-4),4.v 4c v I-'-1RUA PW-7-y FINAL INSPECTION BY:. ------ ------ ............................. ............ Date. I SAN JOAQUIN LOCAL HEALTH DISTRICT 13D South American Street 300 West Oak Street 132 Sycamore Street 814 North 'IIC" Street Stockton, California Lodi, California Manteca, California Tracy, California � eS-9-2M iasaas wrwono ,z-sa � x