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�r { APPLICATION FOR SANITATION PERMIT Permit No. __ r•�p_1--..... � Pr il (Complete in Duplicate) Date Issued __/�__=_C_ ' Applica+ion 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--------- -- ��r----------•-------------------------- l�. Phone--- --------------------------- Owner's Name. •------•------ - (� ---- Address ------- ------------------ -f?�—---------------------•-----------------------------!--I------------ Contractor's Name----- -------' LL Phone.. ------ ---------------- - -il' Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence UApartment House ❑ ❑ l W �1 Number of baths l____ Lot size ---- ----- ---------- -- g Number of bedrooms _--.____ Number of living units: . ' Water Supply: Public syste ❑ Community system �[] "Private � Depth to Water Table _ dit. ,f Character of soil to a dept Il of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay ❑ Adobe Hardpan ❑ p I I; ,Previous Application Made-i Yes ❑ No ®,New Construction: Yes J, No ❑ i I TYPE OF INSTALLATION AND SPECIFICATIONS: , ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I [ Septic Tank: istance from nearest wsll__,_______________Dlstance from foundation__`_____".___.___.Material__""__._______._ilil___"___._..._____ 0 of compartments.__------------ _ Liquid depth------------------------,_Capacity._.-------------------- ❑ --`-Size------------ Disposal Field: 1 Di e� from nearest well. ...............Distance from foundation__________--_.._..;Distance to nearest lot line--_ I um ri of lines----.------•---------=---- ----- --Length of each line -------- Width of trench___�M Type of filter maternal_____-.._-__..-"_ "___._Depth of filter material_'__..__. --- ------ Total length-- !��'. Q.._.__.Distance�o neareA lot line_4Vd �_. Seepage Pit: Distance to nearest well_ Distance.from,f length--- d t, Depth'I1' y, Number of pitsr_ -Lining material__-""..-- --- ize Diameter---- ---------------- Seepage Distance from nearest well._._ "___._____-Distance from foundation__________________dining material__ -_1�___________----_____-_______._. {-De th ---------- -------------------------------------- Liquid Capacity =ill gals. ❑ Size: Diameter--=--------- ---------------- -- per. Privy: Distance, rom nearest well"_.-__-.__.",-:.;---,-- :. i= Distance from nearest buildnng.___ --_•-----------_------------------ r p _ ------------ } �r Distance to nearest lot line----- -�-�----- ------- •--=�------------------------------------------------ �-----------------=----------•--------------•-- -------- --------- ---------------- Remodeling and/or repairing (describe)--------------------------T-- l�i t I ------------------------- -------- ---- ------- i IllI. --------------------- - - - -" ----------------- ----------------------------------------------------- --- 'i�l ---------------=------------ -------------------------------------•------------ �; I hereby certify th�a �l�h ave prepared this application and that the work will-be done in accordance with Stan Joaquin County ordinances, State arules and regulations of the San Joaquin Local Health District. ------------------------------------- and/or Contract ) -- �d--- ---- (Owner and o or ( ig = r +_� I k - -------- -- . _ (Title)- -- --------- ---- - ` ---------------- -- - -� ... - f (Plot pian, showing size of:lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I� FOR DEPARTMENT USE ONLY �N - i cif APPLICATION ACCEPTED BY------------------- - - ------ ---------------------------------------- DATE-- �--1-------------------------- --------------- ---- REVIEWED BY �M c - - DATE---- �I� - - PERMIT ISSUED-------------------------------------- - ------- -----•--------------------------------------- DATE----------- -•----Y�-' -------------------------------- BUILDINGAlterations and/or recommendations:-- ------ - -- -- ------------ ----------------------------•---- ' 1k ....-------- _ t -------��--------------------------------- ------------ -------------------- ----- ----- iM _.._ .._ 1".-J -----------------------••- - --------------- ------------------ ------------ - ---------------------------------- ------------------------ - -------- ------------ 'I1 Date..._1-j-`---�---?'- ---��- �------- -- - F1NAL INSPECTION BY:._-- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tra'I California Stockton, California Lodi, California x Manteca, California cY' ES-9-2M i<5446 ATW tltlO 12-59