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APPLICATION FOR SANITATION PERMIT Permit No.ti.l�'._j(%_Q_ (Complete in Duplicate) (/ Date Issue 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 Ordi ante No. 549. L. JOB ADDRESS ANC TION.-.---- 10 ............... ------------------------------------------- Owner's Name....... --------------- --------_- ------------------ ------------------ Phone_ Address ----- ,-V,W:�Il ! ._•-• .- € ------------ 4 �------- Contractor's Name__.- .:_ �RIV _._�"t-------------------------------------------------------•--------------------__--_--. Phone 6�1 1-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑;,_ .l Number of living units: _____:Number of bedrooms __Number of baths j___ Lot size -----7-41 . - ------------------ Water Supply: Publicsystem4;6 Community system ❑ Private ❑ Depth to Water Ont ...x Character of soil to a depth of 3 feet: . Sand ❑ Gravel.❑ �5andy Loam Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ NoX_ New Construction: Yes o ❑" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVor cesspool permitted if pu6lic sewer is available within 200 feet.) .. . Septic Tank: Distance from nearest w II __Distance from foundation____®_'_____.Material_______�________________ _ __ 1 �/.......... . No, of compartments____ _- ._____ _____:Size r°A_d'i�_ ___ ___ Liquid .depth__�__'r._____._' .i M � ) + . Disposal Field: Distance from nearest well "* -_._'Distal rom foundation_-_A�-___-___..Distance to nearest lot line.-...-._.__±}-� Number of lines_ __�:_____ Length of each line___�&_ -----------'-.Width of french______.__Y_,11_________________ ,i I .: See a e Pit: "�` DYsaeceftloen a estr marlwel material- Vt4b - 'D s+a'n'ceffroterfoundation`_.f,.f� .�postanctal e to nearest lot line---/v __ 6�� p Number of its-__. _ �*___ " -'I Size: Di meter__ �� =r p �` Lining materlale , --- ----Depth----ox'j---------------------- Cesspool: ----------------_--- Cesspool: Distance from nearest well----------------Distalce from foundation---------------------Luing material-------------------.------------------ Size: __._ _______ ❑ Size: Diameter------:---=--------=--------- ------Depth---------------------------------=-- 2--Liquid Capacity----------------------------gals. Privy: Distance from nearest well----.._--------- -----------------------------' _._Distance from-nearest building______..______---_----_______:..___-____. ❑ _ ,.. w.... Distance to nearest,lot line------ --- ----_- R ----------- .-.._--- — ---- '`---------------------•"--=--- EI 3..� Remodeling and/or repairing (describe):` = Jp F.i - _ f I.; . . ill ..J� _. , --------------------------ta, ---------------------------- I hereby ct I have pre-pi 'd this application andF that the work will be done in accordance with San Joaquin County r ordinances, Staand r ulaions the'San Joa in Local Health District.Si ned - ------------- ------ ------- --_-- = Contractor( 9 )------------- _ -- ) 'By: = I . -------------- - {Title}_ ��yu --------------- - -------------------- (Plot plan, showing size of lot, location of system i relation toldwells, bu dings, etc., can be ace on reverse side). Jf R DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY------- -------- e------------ -------------••-------------------------------------------------------------- DATE-----------•- --------------- REVIEWED BY----- =��` = ------------------- DATE--------- --�- --------------- BUILDING PERMIT ISSUED-------- -- -------- M - DATE------------------------------------------------- ---------- 4Alterations and/or recommendations:. --------------------------------------------------------•--•--------------------••--------------------•-- •--- --•-••------•--------------------'------------------ ----------------------p------------------------------------------------------------------••----------•------------------------------------ ---------------------------------------------------------------------------------------------------------------------------- r ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------------ I - 4M ------------------------------------ --------•-- -------- -------------.-- -------- ------------ --------------------- ------------------------------------------------------------------ FINAL fNSPECTION -BY------------ ----------------1------ �� Date'.----_=-=.:''----------------------------------------------••- ----------------• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100 *a