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yPermit ---Il__- -- 1---- `tl � APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) S✓S Date Issued Application is her made to the San Joaquin Local Health District for a permif to construct and install the work herein described. This application is made in compliance"with County Ordinance No. 549. ' s � f --=----------- �Y. ------------------=---------....------ -------------------------- q -• - JOB ADDRESS AND LOCATION...____ -- ---------------- t {� i - e-----------------------------•---- Owner s Name----=-=-- = :1- - 1f{i_ f = -------------- " ram � _ ------------------------ Address -----------------•------------------------------- --- -- --------------------•---------- _____ ti -- t�� - - Contractor's Name q Phone -----•-------------- �.�. .k i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Num /ber of living units: _ __ Nu'mber.of bedrooms -__,-,7 Number of baths _ .'__ Lot size ._._--- ( ------------- Water Supply: "Public,sys#em` Co imunity4sysfem O Private E] 'Depth to Water Tableft. r Character of soil.to—ajl ;depth of 3 feet-:' Sand [] Gravel ❑ Sandy Loam ❑ "Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No gNew Construction: struction: Ye [�°�o ] FHA VA: es ❑ No --. TYPE-OF INSTALLATION AND ®_ r SPE C. IFICATIO_N--S-- (No septic tankWor'cessPool permitted if publi c sewe.r,._ is„ava_ilablem-w-.-ithi-.n_..2- 00 fetet.) Se tic.Tank: nearest well ( xz)tstance from foundation _p------Material---- No atefna`l ___ Notomparfiments_____ - ��_.U_ _ _•__________. =Size �D .-- Liquid dap} _CapacitY___ -------- of A. Disposal Field: - Distance from nearest well_._*d5t6Mstance from foundation____ __ 1 _______-Distance to nearest lot line_ _ -_Q______ 1 r , t} NDuisr#zabnetre of olinneeasr__e-_s_t=we ---?--�----'-LDeisntgatnhceoffreoamch. linre__ _,�d_:.--- ..Width.of_trencth+ ----�----------------------------- $ ---------- "T D °------•-- x Yp enaIe or iterma � material .__� _ length........ ------ fou'odation.._._oaarest lo} line_` See a e Pit: - Number of pits.--------.- Lining material__�a c:./�.--_Size: Diameter__,,, �___Depth______�,.��.___.--_----- __ l Q- Cesspool: ` , Distance from nearest well_____ _____Distance from foundation----------------- Lining material_ ___________________ ------------ Cesspool: _________. 4 ❑ Size: Diameter_ # -----=-Depth-----------------=-------------' ----- - ------Liquid Capacity-------------_---------'----gals. Privy: a Distance from nearest weU__._t.___/_______ ________-_-----------_f.-- Distance from nearest building"t_t________.__-___________----.---_.-. k. -. �. .. M Z... _ ❑ .,. . Distance'to nearest lot line- f �-------- ---- -,--------- - ----'------ -----------------...------------- :------------9- ----=-- ---------- ------- , Remodeling and/or repairing (describe: ' `•------- ----------------•---------------- -•--------------=---=----------------•----------------- ti ----------------------------- ------------------------ -------- • --------------- - �k •-------•-------•----------- =-------- I ` 4 4 I hereby certify .h I have'prepared this application and that the work will be done in accordance with San Joaquin•County r ordinances, Sfate laws, d rules and regulations of the San Joaquin:Local Health District. f ' ;... , Contractor)f - _ _ _-(Owner and/or or) (Signed)---- ----- --- -------- ------ - ------------- ------------------ -- -- -----------------------(Title)-------�_z'- i --- ---------------- By:(Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------.----------------- ----- --- - -----------.:... --------------------------- DATE-----V ----------------------------------------------- REVIEWED BY ---='---'::: -------'--- _ -------- DATE D) TE.-------- BUILDING PERMIT ISSUED----------------------------=------ _ - Alterations and/or recommendations:--------------- --'------- -- ------------- ---------- ---------------------_---------•--- ' ;� - ---------------------- ' _ -� - ~' J - FINAL INSPECTION ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300"West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1•57 F.P.CO.