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APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) t Date lssued� 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 Ordinance No. 549. JOB ADDRESS M�60CATIONJ_ Owner's me------------- --- --------------------------------------------------- -------------------------------------------- Phone fe-417�/—------7----------- Address- L AI ----------------------------_-------------------------------------------- ------------------------------------------------ ----------------- Confractor's Name----------------------------------------PARP,11-3-k------16—rie—_-------- -------------------------------------------- Phone------(9,g-45,-07------ Installation will serve: ' Residence E] Apartment House 0 Commercial Dg� Trailer Court E] Motel El Other El Number of livinig-unit. _/___ Number of bedrooms'_- Number of baths __1_1_�Lof size --- ---------------- y ---------- Water Supply: Public system El Community sysfemX Private El Depth to Wafer Table -642 ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Previous Application Made: Yes L] No X New Construction: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) is r7l'. Tan Distance from nearest_we�l------------------Distance from foundation----------------------Maferiai------------------- ------------------------------ er_7 No. of compartments------------ -- ---- -----Size---------------------------- ---Liquid clep�h--------------------------Capacity------ --- ------------ posail , Id. Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot I;ne--------------- Number of lines----------------------------------Length of each line-----------------------------.Width of trench Type of filter material----- ----------__---_Depth of filter material---- ------------------Total length------------- ---------------- ---------- See ge Pit: Distance to nearest well -----Distance from foundefion-JAP-"-------Distance to nearest lot Number of pifs----. --------- ----Lining materia]M_44----Size: Diarneter--, ---- Depth from foundation-------------------- g Lininma r Cesspool: Distance from nearest well-----------------Distance fei'a I-------A-- --------- El Size: Diameter--------------------------------------Depth------------------------------------_....... ------Liquid Capacity- --------------------- Privy: Distance from nearest well--------------- ----------- t ---------------------Distance from nearest building----- ------------------------ ----- -- ❑ Distance to nearest lot line-----------,----------- ---------------------------------------------------------------------------------------------- Remodeling and/or,repairing (clescrible):---------/---/ �------- --------------------------------------------I--------------------------- ----------------------------------------------------------------------------------/7 — ------------------------------------------------------- -----------------------------------------------I----------------- ----------------------------- ------- -------------------------------------------------------------------I---------------------- -------------------------------------- -------------------------------------------- -- --------------------------- ------- ---------------------------- - •-------------------------------------------•------------------------------------------------------------------------------------- . I hereby c rtify hat I have pre red this application and that the work will be done in accordance with San Joaquin County g ordinances, and les an regulations of the,jSanJ uin Local H A District. and in L' (Signed)- ----------------------- -------- ------- - -- ----------------------------------------- Contractor By----------------------------------------------- ------- ti/- ---- ---- -------(Title)---------------------------- ----------------------------------- (Plot plan, showing size04 lot, location 0`4';ystern in relafl to wells', buildings, can be placed on-reverse side). FORD PARTMENT USE ONLY APPLICATION ACCEPTED BY----------- BY--------------------------------- ---------------------- DATE------------- 2 - REVIEWED BY------ DATE , ----------Z------�:--_------------------------------------------- - BUILDING PERMIT ISSUED- -------------------V-------------------------------------------------*------------ DATE Alterations and/or recommendations: ----- ------------------- - ------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------11--------------------------------I-----------I------------- --------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------------ -----I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- -------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTIONDate---.V SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California t Lodi, California Manteca, California Tracy, California ES-9-2M io-52 Revised W-2100