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APPLICATION FOR SANITATION .PERMIT Permit No. (Complete in Duplicate) o Date Issued ----- -�- .. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.---------- � J� �ALC�r `--------- = Owner's Name------------- r -------•-- Phone_- �q . Address........................ a Ct.� 4,0W I--------------------------------------•----•--------------------------. --- --- ------ ._ Contractor's Name---------_--•----------- _W14V_4 :7? 4� 7/ Phone----------------------------------- Installation will serve: Residence V,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _tK" Number of baths A_-_. Lot size -----------��2 �Cs�_1�____________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _4.� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe M/ardpan E]Previous Application Made: Yes L] No No New Construction: Yes o ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: m t(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic/Tank: Distance from nearest well__/d6/O Distance from foundation_/ ----------Mate ial__./&_?_.400-Q No. of torr:partments----_---.Pr.--------.--Size.,��--C/_-X-.t7-__Liquid depth--------- -------------Capacity ------ ---�----- i Dispos Field: Distance from nearest well'7_0WJ,—`Distance from foundation-----A0 _:_.___Distance to nearest lot line.__r........ [ Number`of lines___...-----/---------------------Length of each line----------- ------------Width of french---------�2 _if_ Type of filter material_ _C,1%4_„___Depth of filter material______ -..__.Total length--_---- -- Seepage-Pit: Distance to nearest well_--------------------Distance from foundation----.---------------Distance to nearest lot line----------------- El. ______-________❑. Number of pits----------------------Lining material--.--------------------Size: Diameter---- ---- Dept h------------_-------------------- \ Cesspool: Distance from nearest well-------------_---Distance from foundation-_.-----------------Lining ❑ � �1r material_ __________-----_____ Size: Diameter--------------------------- - -------Depth---------------------•---------------------- ----Liquid Capacity-...• ----------------_--_-_-_-9__a__ls_ Privy: y Distance from nearest well-------------------------------------------------Distance from nearest building--------------________________._______ ❑ f Distance to nearest lot line--------------------------- -------------------------------------------- ------------- --•---------------------- Remodeling and/or repairing (describe):-------F4r0_0,--------S1 _ti /k"r-----"f------ -----------------------••----•-=------- --•---------------------------- --------------------------------- ' ------------------•----------------------•---•-•-•------------------------------------------------------------------------------------------------------------------I------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulatibns of the San Joaquin Local e �istri t�r �Aigne,r�} �( • ---- --Owner and/or Contractor) - - -- - ----- U (s Tale - --- - -- ---- (Plot plan, showing size of lot, location o system in relation to wellsi buildings, etc., can be placed-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- ------------- -------------------------------------------------•----------- DATE---------- a� -- -------------------------- REVIEWEDBY----------------------------------------- ---- ------------------------- -------------------------------------- DATE.. -- BUILD.ING PERMIT ISSUED-------------------- ---------- ---------------------------------------------------------------..__ DATE------- ---�----------- Alterations and/or recommendations_______ ___________ -------------------- ------------------ - r ~^ -•-.---._ ..... ��,e ----- ha1r Fi.��°�!_......I / e r '-- f' ------------ - : ---=--------- ' � �-� ----------------------------------...------------------------------------- ------------- FINAL INSPE@ ION BY--------- � - ---------->-- -- --- -----------------------.------- Date------ - --- AI--SAO� SAJOQN LOCAL HEATH' 1STR1� ` 130 South American Street 300 West,Oak $+reef 132 Sycamore Street 814 North "C" Street (Stockton,.California Lodi, California Manteca, California Tracy, California / ES-9. M av�sad W_7100 n