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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'sapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....fj_r7iF------- Owner's Name------- _fob__jo- ---------- ------------------ -------------------------------------------- Phone-------------------------------- Address ----------- -------------- ---------------------------------------------------;! ------ •--------------------------- -------------------- --------- Contractor's Name...---_ --- .... ------ 2. - Installation will serve: Residence [C[-`Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other E] Number of living units: ___t_._ Number of bedrooms 3--- Number of baths size ---------//Y ----------- Water Supply: Public system E] Community system 17-1 Privatew-6epth to Water Table S_4:Pff. Character of soil to a depth of 3 feet: Sand L] Gravel [-] Sandy Loam L] Clay Loam 0 Clay [] Adobe ff"""Hardpan Previous Application Made: Yes El No New Construction: Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from n -k earest well-64- Distance from foundation__-Z-49- _.Material_____----Material_-- ----- ---- -------- c - -------- No. of compartments----2.�------I...... ---Size-3-1 ----Liquid dep'th-A-1,11- - -------Capacity/ Disposal F- Id: Distance from nearest we1l__64_`_D1s+ancet1rn foundation./,67----Distance to nearest lot line------ ------- - -e----- !7------------Width of trench...... 7-- .'re e.4-- Number of lines______j ;9 Length of each line----74- -- ----- A j Depth of filter material---------- ---------- Type of filter material___ Total length__/--- ------------ Seepage"K., Distance to nearest well-ir!______Distance M foundation__-_-.Distance Distance to nearest lot line---- De Number of pits-----f-------------Lining material-&( Size: Diameter.......M__`07----Depfk-,-.P- ------------ 5------- --- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- 11 Size: Diameter------- --------- ------- .---..Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-...-- --- --------------------I_ -_ ___----D;stance from nearest building___._____.__.______----______.__..____ ❑ uilding--------------------------------------- 0 Distance to nearest lot line-----------------------------;---------------------------------------------------- -------------------------- Remodeling and/or repairing (describe):-------------------------- ------------------------------------------------------_--------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------- ...... -------------------------------------------------------- -------------------------------------- -----------------------------1------------------------------_---------------I--------------------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Joaquin Local Health District. F DAY NIGHT (Signed).19&------- -- ----- -------------------- -- --- -- ------j Contractor) 120---Sopyff-Tonlik Service -------------(Title)-- - -------- B ---- - ---140-2470e4------ --------------- $W,'n, 4NAIRPynWitystem n- ion to wells, build/gs, etc., can be placed on reverse side). (Plot plan, s owing size of I i re FOR DEPARTMENT USE ONLY ----------------------------------------------- DATE APPLICATION ACCEPTED BY--------- - - ----- -------------- ----------- -w-----------------------------------;� REVIEWED BY-------------------------- ------------------ --------- ------------------------------------------------------- -------------- DATE_..-------- ----------- I BUILDING PERMIT ISSUED-------------- ---------------- ------------------------------------------- ------- --------- DATE----------------------- Alterations ATE-----------------------Alterations and/or recommendations-------------------- --------------------------------------------------------------------------------------------------------- --------------------------------- •--------- ------------------------------------- ----- ------I-------- ---------0----e2-g-p-4-------- ------- --------------------- - - ----------------- --- ----- ----- ---- --- ---------------------------- - ------------ ------ -----•----•----- ------------ --- --- ------------- ------------------ ------------------------------------------------------------------------------------------------ ------------------------------- ... . ----->S..................... 1z" ----------------------------:----------------------------------------- --I---------------------- FINAL INSPECTION BY:---- ------------------------------------- Date_.� - 3 -- ---------------------------------------------------------------- SAN JOAQ UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M '45446 wTw000 'z-s4