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APPLICATION FOR SANITATION PERMIT Permit No. ----. 5 (Complete in Duplicate) Date Issued . _..�� ..-•--�J��- ' `Applice}ion is hereby made to the San'Joaquin Local Health District for a permit to constrLct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A D LOCATION.--- "--F------ 1'J7-E!'---- ------ F•- °- '- -•--lqol/0(...... �� --- - + Owner's Name--- A_------ ------------------ r--- --------------------------------------- Address.............1-" f'�.f`7>t� !L4a , �� L�----------------------------------------- --------------------------- - Contractor s Name------- -- 7-------- -_ -�- - - -------- --+----- --------------- ------------ Phon ----- Installation will serve: Residence ❑ Apartment House ElCommercial E] Trailer Court E] Motel ❑ Other [�� Number of living units: -*--Number of bedrooms —Number of baths of size ------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table --_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑~ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public seer is available within 200 feet.) Septic Tank: Distance from nearest well__/ --Distance from foundation-,k-----.-__ Materials .....e- 4e ..- ---.. No. of compartments-----�--------------Size- ---_ -4?---.-_.Liquid de th---- --------Capacity-Z O---.-. Disposal Field: Distance from nearest well./.$—.b---.Distance from foundatto nearest lot lin`� - [ / Number of lines_ Length of each line-//17__7t ---.---.Width of trench------RZ�-------- Type of filter materialt�`tiS._Depth of filter material--,/j&_4---------Total length------ eQf" "--^— " /:--------_-- }. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot kin ---- ------ [ . ElNumber of pits------------------- --Lining material----------------- _ -Size: Diameter----------------------Depth__--------.----- -�,,,i,"'•�J Cesspool: Distance from nearest well----------,-------Distance from foundation--------------------Lining materiaL_.____------------.--------------_-- Size: Diameter------- --------------------- -------Depth---------------------- -----------Li uid-Ca acit .Privy: Distance from nearest well-------------------------_----------------------Distance from nearest building----.______._---__-__---__-..-.--.----. ❑ Distance to nearest lot line----------------------------- --------------------••--•-------•-•---••----•------------------------------------ ---------------------------- Remodeling and/or repairing (describe:_./v--_.. v0-6'-CZ___•_-__- L tJ--------( Z- '._.--..---._ --------------------------------------------------------------•----------------------------------------------------------- ----------------•---------------------•------ Y-----------------•-------.------- j ---------------•--------------------------------------------------------•-•-------•--------•-•--------------------------------------•-•---•------••---•------•---•----------------------- - ! 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 and regulations of the San Joaq in Local Health District. _ DAY&NM1 i ------- (Signed) —Contractor) -------------- � �,. � fie--Yernk--Sam--�,,--------------------- ------ Y' , ., p Sc Fte}nrado � 0 � - -- -- - --- - ----- - --(Title) (Plot plan, showing size of lot, oca tonnof'sy'sfem in relation +o ells, ulldings, et , can be placed on reverse side). s b FOR DEPARTMENT USE ONLY '} . REVIEWED BY 1".� -:�^"------------------------------ ------ DATE APPLICATION ACCEPTED BY-------------_- - ------ ------------- ----------••------••-----•-------------- DATE--------- �- :- ----------------- I ::.::.:.:.:.. BUILDINGPERMIT ISSUED----------------------U-- -------------------- --- - ---------------------------------------_- DATE.----------------------------------------------------------- ' Alterations and/or recommendat ions:--------------------------------------------------------------------------------------------____-----------------------------•---------------------------- ------------------------------------------------------------------------------------ -------------- ------- ---------- ------- -•---•-------------------------------•---------------- --------------------------------------------------------------------------------.----------------------------------- --------------------------------------------------------- FINAL INSPECTION BY:--- ------- ._ ------------ -------- ------ Date------------------ --- 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, Californis Tracy, California r' Z5-9-2M 145446 ATwppo 12-54