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APPLICA ION rOR SANITATION PERMIT Permit No. ...i (Complete in Duplicate} /d Date Issued ___..._!� Applica+ion is hereby made to the San Joaquin Local Health District for a permit fo:construct and install the work herein described. This application is made in compliance'with County Ordinance No. 549. JOBIADDRESS AND LOCATION-------- __ " �r" r __�...__.-" e� _. c___._ , _ ___ Owner's Name------------� L a ----------- --Q------------------------ ---= - --- - -- Phone-------------------- Address------------------------._ --------------•---------------------- -----------________-"""-- --------------------------------------------- Name.._ --•-- --- i -, " - -- ------ �— e ----------- Contractor's 7 �r! --�------- . -C-- --- Phon Installation will serve: Resident �+�/Apartm1ent House ❑ Commercial El Trailer Court E] Motel E] Other E]Number of living units: ..../[] Number of bedrooms .__Number of baths __�__ Lot size moo" "------ -_��_��"-""-"""••---__-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --1;Gf. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑.., No ew Construction: Yes ❑ F No TYPE OF INSTALLATION;AND SPECIFICATIONS: No septic tank or cesspool permitted if public se er is available within 200 feet.}� VVV - 1�- • S �a Distance from nearest wel_•___ ___ _______Distance from foundation.-.-/-.___"-_._-_- Material-__"""_-".""__.___...._"-_-_".._--._____.______- No. of.compartments- -------- - , ------- Size--------------------------------Liquid depth ---------------------Capacity----------------------- osal 3 Distance from nearestwell._��Distance from foundation___%57_ .Distance to nearest lot line___�U..r_ Number of lines.-.___-_ Length of each line_"__ ' - �'- „ � 9 �-�---------- Width of french- - of filter material ( Depth of filter material-__..-- --_Total length---ra-✓-__! r ------------ Seepage Pit: Distance to nearest well.. _ ,/ - ___Distantili� ndation Dista c� to nearest lot line__.___. Number of pits..._-........__-_-Lining material_________ _____Size: Diameter__-- ---�__-Depth----.� ------------ Cesspool: -'�- 4 �\A Cesspool: Distance from nearest well-----------------Distance fro _ ndation._--'-___.___ material-_..""""___.-____---.__".._.-_____.- Size: Diameter------ .---_-- ........Depth-----:-----'----------------- - -------------------Liquid Capacity ---gals. Privy: �Disfaneb.from nearest well-----------------------------------------------..Distance from nearest building----------------------------------,----•- ❑ Distance to nearest lot line..------------------------------- ---------.---------••------•-•--•------------------ Remodeling and/or repairing (describe):--------- w ---- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------•-------------------- ------- _.-__-"_-.__"-____"-__"_________ __ _____ ________ -------------------------------------- - ...___..__.__________..__._ 1-hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY&NIGHT -". G [Signed} 9sing ------....-•-1i"lic Tank-Servide-------------------------- ---------------- --------�--- -------- -----A�*tr-Contractor) 1206 So.E_Idorado HO 2-7046------------ - ,�--. ___- _ Title "_ - eY• tS�$ d Stem 1n relatio wells, buildin s, ( }Plot plan, size of to , g tc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- ----- :___'.------------------------------------- _ DATE-- -- REVIEWED BY-----------•-------------------------------- ---- DATE_--- BUILDING PERMIT ISSUED----------------------------- ------ DATE--------------------- Alterations and/or recomm dationsi_____________"-__..._..___ ' ' - - - -- - -- ----- ----------------------------------------------------------- -� --- -------- ----------- ----------------------------------------------....._ --------------------------------- --------------------------------------------------•--- -------------'---------------------- ---------------------------------------------------------- --"-- I FINAL INSPECTION BY:--------- -- -- ......-----"------------------------------- Date. 1"'� I 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 ES9-21A 145445 ATWOO❑ 12-54