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T �h APPLICATION FOR SANITATION PERMIT Permit No. �� /U ✓1 (Complete in Duplicate) _ .........'+'+.."w+.r"'•vi _op1%4. - -r'+TTT^F^.r^'_"r^ ... �... --4,.„- .._ . {/ Date Issued _ Application is hereby made to the San Joaquin Local Health District"for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. + : JOB ADDRESS AND LOCATION 1G2r ;Kae ---- ------ - Owner's Name-------------= / _------ ------- - ---- ----------------- --- ------ ------------------ Phone_`--- /t r` + .. �•l .. - -Address- ,( , ----- - ---:-_--- __ ,., t. Contractor's Name--- �.... Y ... = f -------------- ..t--------------- PETo"ne_ _ Installation will serve- Residence [� Apartment House ❑ Commercial ❑Trailer Court ❑ Motel' El Other E]. } / 1 S Number of-livingIunits: _ __= Number of bedrooms❑___ Number of baths _-__ Lot size_ . _� _ �__ -____.________._-__.-- Water Supply:-'Public' system Community system Private Depth to Water Table.- a ft. Character of soil to a4depth of 3 fee+:` Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑.z Clay [] Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ �No�KlNew Co#struction. Yes ❑ No rHANA:,.Yes ❑ No� TYPE-OF INSTALLATION AND SPECIFICATIONS:• = ' (No septic tank'or cesspool permitted if public sewer is available within 200 fee+.) -; { Set Tank: s Distance from nearest well- -__- Distance from,found�jion__, at ria�_� (a_.__.�iN ___________ __ { No. of compartme{ts___- `----------------Size__- ?�- �_,;.L'iuid de th--- -`------ -_ py_•-- ®0- �- pp a acs Disposal Field: Distance from nearest well---- Distance from fo "dation_ ___V6---------Distance to nearest lot Number of lines-- ----- Length of each line------��7-_-.------__--WidWof trench----- -------- ---------- ..Type of filter material____° /(%---'Depth df filter rhaferial----1-f_�f_____--Total length-- ____, �._f_____________________ dr SeeXae Pit'.'—M .. Qistance to nearest welt f�Q_ : __-_Distance from foundation_.- l __"__.Distancl'to'nearest tot iir4e ---- Number of pits________________ _ Loring materia ___5ize:,Diameter:_._JU_._ ___..Depth___.,2J____' __._-_- p Size: Diameter_______ __________l- -------r Distance from foundation--------------------Lining.material-------------------.-----------__,._-,_. 5 ❑ t r ;._.- Depth----------------------- -- ------=--Liquid Capacity .--gals. Cesspool:: ' Distance rom nearest we ___ Privy: Distance from nearest well r-•-�- Distance---°-----------•------•---...; from nearest buildin5------------------------------j----------� G)•r Distance'to nearestSlot'line-'- .-� -- *------`=-----•- ------ ----•------- ---------------- Remodeling and/or repairing (describe):--------''�'-_________€ __= :__ - l -------•-------------------------------------------------- -------- -' --- --------------- - ---•--------------- I hereby certify that-1 have prepared this application and that the work will-be-done in accordance with.San-Joaquin County ordinances, State laws; an les nd regu n of the San Joaquin Local Health District. ' F -------------------------------------- ---- (Signed)•-=-------•--------- ---- -&- •----• ---�----- ----- - --� - ----- - -- --- - ---- -- .{Owner and/or Contractor) By:--------------------'--------------- = - ------(Title)---- (Plot plan, showing-size' of lot, location of system in relation t w IIs, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY r ]� APPLICATION ACCEPTED BY ' �+r ---------------- DATE ---� REVIEWED BY-------------`--- ----- -------- -. --' = - ----------------- DATE - BUILDING PERMIT ISSUED----------------- ------------------------------------------------ = - ---------------.---------=-- ----------r--:: DATE---------------------------------------- Alterations ----------- - Altera+ions and/or recommendations: -- ---------------------=-------------- -- - ----•--- ...Y ------------ T -- - -! -- --- - - - + � ' -------------- ------------- a . ----------------------------------- -------------------------- ------- ------------ --- ------ -------------------------------------- --- ---- ------------y ---------------------- -----------------,--- ------- ------- -------- ------ FINAL,INSPECTION BY . _ l --`--- ---------- Date --- _=/ ----- !/f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street. Stockton, California Lodi, California Manteca, California Tracy, California > % .ES-9-2M , Revised 1-57 F.F.CO. '