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15q l 3a a`1 35-r-; - 3(�E . APPLICATION FOR SANITATION PERMIT Permit Na.. "-D 1Q (Complete in Duplicate) Date Issued .Y__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. JOB ADDRESS AND LO TION ---- --- -- � _-------- ? ______________________________ Owner's Name--------------- -------------------------------------... Phone-_-----------------_---- r� --------�P -- --�? -- -- --•----•---- Address -----•-----•-----... ------ _,_.e Contractor's Name------ ------ 7 --------------- Phone -------------- -------------------- Installation will serve: Residence PRIApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms 9--_ Number of baths;/__- Lot size _-- %�_f1.(-/1-------------------------------- Water --------------------------- Water Supply: Public system gr,�Eommunity system ❑ Private ❑ Depth to Water Table-.-4a-,ft. ., Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B --Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes R3"r4o ❑ PHA/VA: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well ------ -- --._ Distance from �r �foundation--._ �Q_-_,-_-Material --- __ --�-----_-_-.. No, of compartments ------- iz______________Liquid ._�__ Capacity-, Disposal Field: Distance from nearest well _-_-fi---------- Dist ance from foundation--- Ze.-------- Distance to nearest lot line.-.� ----- 94--- Number of lines----_-- --_ .- _ ---Len9th of each line ------- -Widfih of trench ------y" ---------------- -- Type of filter materialIA-A Depth of filter material____ Total length _--____�o�,�.I-------__--_-_- Seepage Pit: Distance to nearest well -----.-----__-_Distance from foundation_Z,lsf_____ _.Distance to nearest lot line --- rn� Number of its p _______Lining material: �d__Size: Dia'rrieter___-_--.`-Depth----42+�.- ------- --------- --------------- Cesspool: Distance from nearest well ----------------- Distance from foundation --------------- _---- Lining material _______-_----.--------__--.____----. ❑ Size: Diameter_-- ----.:------------------------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well-------------------------------------------- ---- Distance from nearest building __---...---------_-__-__--_-___-._-_--. F1Distance to nearest -lot Iine ------------------------------------------------------------------------------------- --------------------------------------------------------- _v; Remodeling and/or repairing (describe): 'Le` z --------- ----------------------•-•--------------------•----•-------. -----------------•--------------------------------------------------------•-------------------•-----------•-------------------------------------•---------------------- --------------------------------------------------- -------------------=-----------------------,-------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that fh'e work will be done in accordance with San Joaquin County ordinances, State laws, and rules and, -regulations of the San Joaquin Local Health District-,-, w : Wo - {Sign(Signed) ed} ~' ------------- ---(�r Contractor( B By: --------------------------- - - --- ---- -------------------------------------- Ti+le (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can 6e placed on reverse side). YOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-;.-- -•-------------------------------------------- DATE------ REVIEWED ATE----- REVIEWED BY------------------------------- - =---- --- ------'.DATE-------------------- --------------------------------------- BUILDING PERMIT ISSUED --------------- --------, --------------------------•-----------------------------------=- DATE Alterations and/or recommendations -----------------------t------------ - --------------------------------••-----•-•----•-----.------ ------------------------------------------- ------------------••- - /i,( Rn-------r!-T-------�-s--------o h' f� ------------------------------ ----------------------- —x,10_14--------P'T' --------20....-....6_-K�-----`F0------�5&Np:------..T� IKU ---------- FINAL INSPECTI�[�✓� Date----..�--_� - j' {SAN JOAQ.UIN LOCAL HEALTH DISTRICTS 130 South American Street Stockton, California ES -9-2M Revised 6-'59 F.F.Co. f, � 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California l-..