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f } APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --.-- Application 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-----------,��j -�/ -- �i�O-,/�-CIG-�-- -------------------------------------------------------------------------------- 16wner's Name--------- ---------•.r----. -------------- - -------------------------------------------- Phone-----------------------•--- Address ...... / -� 7 Contractor's Name 4 t ' _0_A.C------------------• -------------------------------------- Phone : -�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms Number of baths -/----- Lot size --- �_,�_-.,�-.�-___________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ff. Character of soil to a depth of 3 feet: Sand ❑ Gr LE] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No 0,,441 /VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: �/�-'`' istance from nearest well---------------- Distance from foundation___________________Material-__________-_.______________________.._____--. No, of compartments------- ------------------Size--------------------------------Liquid de pfh--------------------------Capacity-•----------'----- Dispo al Fi I _ istance from nearest Distance from foundation---/D________-Distance to nearest lot line._a�___--_____ Number of lines-------- --------- :____ --Length of each line------ ,Q---r---------.Width of trench---G -�(-i'.--------------------- \ j Type of filter material ta_c. _____Depth of filter material------)_#......------Total length_______ --------------------------- C Seepage P' . Distance to nearest welf____C ------------ from foundation-----)_0___-------Distance to nearest lot line_S5__!_______ F Number of pits-------1-------------Lining material__-_T_P_c,_1r____-Size: Diameter---3 3_.._.--_______Depth_.___a�__/_-------_-____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material-------------------------------------- 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ________________________________________________Distance from nearest building------------------------------_--------___ ❑ Distance to nearest lot line---------------------------------- - ------------------------ ------------------------------------------------------------ \' j 'n r �f�/ Remodeling and/or repairing (describe):-------- ---------- -- -- --------- -�-�_�--- �-�->!��!z� ---- -•------------------------ -------------------------------------------------------- (------------------------------------------- -------------- -----------------------------------------------------------•-----•---------------------------------•-------------------------------------------------------------------------------------------------------------------------- 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, and rules nd regulations he San Joaquin Lo I Health District. 1 (Signed)--------- 7- q�----------- --- {Owner and/or Contractor] B -------------•--•-._ .. l�...eA- �� Tale ----------- Y - - -- ( � )------ (Piot plan, showing si ot, location of system in relation to wells, buildings, scan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- ------------------------------------------------- DATE---------8'--/-2 - --------- REVIEWED BY-------------------------------------------------------- ------------------------------------------------------------------- DATE---------------- -------------------------------------- BUILDING PERMIT ISSUED--------------- ----------------- ------------------------------------------------------------------ DATE---------------•---- . ------------------------------------------------------------- Alterations and/or recommendations_________-----------------._._-/-_-______-....___ ________ =--------•----------------- -----------bFF—rft----------' -----------------tee ------------------------------------.-.-------------------------••---------------------------------- ------------------------------------------`-------------- • - - - ---------------------------------------------------------- ----------------------- --- ------- tr�14---- `` "" C''�f1(1�f l_Ql�SS _-K----------�� ------------------------------- ------ FINAL INSP ' :- -- Date---------977 � ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 1.57 F.P.CO.