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'� ✓ � Permit No. so ` APPLICATION FOR SANITATION PERMIT ^ ; (Complete in Dupliicate) Date Issued .rocIV„P( frit = ,. c am rcr F Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. E `This application is made in compliance with County Ordinance No. 549. ------ tw 3 ` -----. ---------- -- f JOB ADDRESS AND LOCATION-- Owner's Name-------- -t.-✓,---- ---->------------------- ------------ ---- ------ Phone-- --- ------ ---------- ---- Address----------- r -----------------------------------------------------------------•----------•----------------- Contractors Name-------D.quL14 L,__ ---- •--------- PhoneA6----- - -------- ----- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ �Mr --- Motel ❑ Other ❑ Number of living units: _--I---- Number of bedrooms .-I - Number of baths -__�--- Lot size -_-/yJ/- ---- ------------------------------ tem Supply: Public system Community system 0 Private ❑ Depth to Water Table X`�. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam El Clay ❑ Adobe �i`lardpan E]Previous Application Made: Yes J] No �ew Construction: Yes R-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------_--.--.-----Material -.-----_--..--.-_._-_.------____.-_..-----.--. C. � No. of compartments-------------------- ----Size..------------------------------Liquid depth------------------------ Capacity------- --------------- Disposal -------------- f Dis osal 'Fio : Distance from nearest well------- ---------Distance from foundation--------------------Distance to nearest lot line-----'-.__-----. - p ..r �. Number of lines---------------_-------- - ----Length of each line----------------- -----------Width of trench----------------------- ------ , -h -_ Type o£ filter material-------------------------Depth of filter material--- -------------------- otal length------------------------------------------ i .-----------.---------_----------------- --.Distance to nearest lot lin -- l' Seepaq�iPit: Distance to nearest well__ �'-_---Distance from foundation-----.-_- -_ _ �r ---------- y. Number of pits--------r.-__.-------Lining material--- ---.Size: Diameter----------4.-______-.Depth-------------------------------- Cesspool: Distance from nearest well-__.-_---------Distance from foundation------- material---.-----..-------------.------_--.-- ' ^J” El Size: Diameter-- --- -- --------------- ----De th--------------------------------- - .--------------Liquid Capacity,.-----------------------• a 3 Distance from nearest buildin ,R Privy: Distance from nearest well____-__-.- ❑ Distance to nearest lot line-------- --------------------- --- ------------- - ------------------------------------------------------------- � - ---•-- - __ -�--- --��--------------,�� ----- ~ Remodeling an r repairing (describe):-------- ----------- -- -------- �. ---------------------- --""-• --..-•---_-----_•_-- w— L ----- ---------------•---------------- --.•_--------------•-----------------------_----------__-----------------••-_-_-_----•-----•-••-__------_------•--•_-----_-_--•-_----••-_---__.....__-_-__.-..-----_--•-.-.-----.-.-..- 11 1 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 and regulations of the San Joaquin Local Health District. er Contrac -------------------------- (Signed)___ C` '` ------------------- - -- --- ----- -------------- ----- -� (Own and/or tor� BY� ---- '------------ ------- -----t (Title]- -v1- ]- (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse si e). eqi FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY--------- ------- --------- - ------------- --------------- ------------------ DATE_ ✓�� --- ------------------------- REVIEWED BY----- ------------------- - ------------- - --- ----- ------------------ ------------------------------------------- DATE---•------ - ---------- BUILDINGPERMIT ISSUED------------------ ---------------------------- --------------------------------- DATE---------- ------------------------------------------------- 'Alterations and/or recommendations------------------------------ ---------------------------------- ------------------------------------ --•----------------------------•-------------------------•- -------------- ---------------- ---------------------------------------- ---------------------------------------------------------------------- -----------------------------------------------------------.------------ -_...-,— ---------- ----- -. ----------- ---------------------------------------•------------------------- - ------ ------------- ---------•------------ ----------------- FINAL INSPECTION � �C �' -------------------• Date-- /� J---------------------------------- BY::...: ......._� . 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 145446 ATw000