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V 1 APPLICATION FOR SANITATION PERMIT Permit No. ..$ ---1_-_ __. lu (Com pete in Duplicate)) Date Issued Application is hereby made to the San JoaquinLocalHealth DiOrici for a permit to construct and install the work herein described. This application is made.in_compliance with County fQrdinance No. 549. e JOB ADDRESS AND LOCATION.... ---7 - �! CQd Cr_�. �-� - i -- • ------..._ Gc� 2'--------------------------_ _ - . Phone_ _ Owners Name_----------------------------------- _�'-�= ---;�:�---�--- ---------�- - -'- - - _ - -- ---- ------------ Address -- - --- - Z6Z ' Address-------------------------------------- ----- --'--- =-�---�- ----�- ----- --- --- Contractors Name--• -----------CAS ------ A _ u .5✓4.14,f _. ------ ----•-------- Phone................. Installation will serve- Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1__ Number of bedrooms _ _---- Number of baths -_�_-_- Lot size =--___-_________ Number of living units: __: ` l"` �{X �O Water Supply:,'Public system, ` ",Communify-system []—'Private ❑ 'Depth to Water Table Character of soil.to a'-depth of'3 feet:''Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loan' ❑ . Clay ❑ Adobe,k Hardpan ❑ Previous Application Made: Yes ❑ No� New Consfiruction: Yes No ❑ PHA/VA: Yes° No ❑ s TYPE OF INSTALLATION-AND SPECIFICATIONS: t (No septic tank-or cesspool.permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- -' -- Distance from --> - foundaton---_ M ------- _ __----_--- --__ " _____-�'No. of compartments__: x _Liquid dePth------- ----CaPacitY-_ ---__ --- - _ __ Dis o'' I Field: Distance fror`r�,n ar `well__'7 _.' stance from foundatio --- -__-.--Distance to nearest lot line____ ...._.. Number of lin ength of each lirr _---_ _-----. idth of french-_------ :_ ype of filter mat e`rial__._._ ..._ �11�epth of filter materiaL_.:_7(Q�-_----;Total length___________-__ ; R . ------ See age Pit Distance to nearest well _`1� � - Distance from foundation?".�_0__�`"`".Distance to nearest lot line __ �__ \ Number of pits----_� _ �Uning material ____.Depth ;_____ }} c 1 C JOKpool:"" . Distance,.from neaTesfwell r_ Distance from foundation__ ________ ____ Lining material____. _. ._____...__ �t_'_ i 4 # Liquid Capa ' __ els. Size: Diameter'•--�'-'-- --�;----------- ---'-:----Depth-=---�== ------=--------------'-------- ------- q P Y------- -•------'-------- 9 Privy: Distance;from nearest.walk----,-x--^- - 1building'`--- ------------ ---- Distance from'ne'arest ❑ - Distance`to nearest lot line__ ---___.._,_ _ ------------------------------1--------- r-------------------------------------------- -------------------- Remo /o (describe): IA :---------------------------------------. ------ i. -------------------- Remodeling and/or repairing (d �_ � j � � r ,. � , f . ------------------------------ ------------------------------- -•------------ ----- ---- t .. . .---------`--------------------------------------- . ► - 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 regulate ns of the San Joaquin Local Health District. _ (Signed) ---- ._:--- ---------- ------------_-----:--------------------------------:----- ----:(Ow and/or Co Tact t � � (Owner nt tTile --------•--•------- --- ----•------,----,:----------------------------------------- --------------------------------------------- ( } = ------------ By: ;---- (Plot plan, showing siie of lot, location of system in relation to-welts, buildings,'etc., can'6e placed on reverse-'side). . '}, ;,*„FOR DEPARTMENT_USE ONLY' APPLICATION ACCEPTED BY ' ! = ATE REVIEWED BY------------' ----- --- -- --- ----. --------------- ----- DATE--- ----- ----------------- BUILDINGPERMIT ISSUED----------------- ' ="--------- ------`- `-------------------`---------------------- DATE----------=----- -----------:------- ----- -_------------ Atterations and/or recammen ations:--- ---- `--= ---- - t -- '. _ Zz_!5� -� ----- _ Y --=,•-y. --------------------------•----------• -- .... - -------•--•--•---------`----------------------------•-----------------'--•--•--------'-------------------'----------------------- --------- _4_ r. s . Y � FINAL INSPECTION Date--'---; --------=-- =- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree4 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised 1-57 F.P,CO-