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_~* APPLICATION FOR SANITATION PERMIT Permit No. y (Complete in Duplicate) 4 Date Issued --yfp! /- --�y 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 AND LOCATION-------------- .'" '_- -*_ --------- �%O�--------------------------------- Phone-.4 -- jy/ - Phone_. � ----AOwner's Name--------------------------------------- pJ Y----- Address-.--------------------------------- ddress--------------------•-------------- _-'Wr_.rz_e-- -------------------• -------------- _--------- --------------=------------------------------------- Contractor's Name----------------------------- s_ -- -•---- �'---0 - - ,S<' ----- Phone-f installation will serve: Residence ;K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __/V //_ __ Number of baths ________ Lot size ---AD'_X__A57 --------------- __�___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,-9ft. Loam Cla Adobe Hard an ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay ❑ y ❑ p Previous Application Made: Yes ❑ No�L New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j p�t�ic- nk: Distance from nearest well________________Distance from foundation--------------------Material -________________._______--____________________- 7L> {" r- No. of compartments--------------------------Size----------------------------•---Liquid depth--------------------------Capacity-----------------------Z D'sposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line___________-___- Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- ` Type of filter material-------------------------Depth of filter material----------------------- length-------.______________________---------- See a e Pit: Distance to nearest well--�O1ClfG______Distanc fro fo dation_f;�___________.D tans to neares�fot. i,--� ---•-- - Number of its_____ g material___ Size: Diameter__y3�________.Depth _J )_ ___ -------------Linin t" p - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________---____________-____311� ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------=---------------Distance.Jrom. nearest.building------•----------------•-------___ . - J ❑ Distance to nearest lot line----------------------------------------------------------------- -----------•----------------------------------------------------------- Remodeling ---------------------- Remodeling,and/or repairing (describe):-----------=-- + yt ----- ------------------- -'k' F li-y 4: �I*--------- --------T�--- __°ltl!, / ----------�---� ----- ---i+--=�----------- -- -- - - ------ - ------i)------•---------------------- ----------- ,�L - afs[y"1 4 i 01 I hereby certify that I e prepared this application and that the work will be done in accordance with San Joaquin County_ ordinances, State la s, an ru s and regulations509 San Joaquin Local Health District. /'�5..___ - /� Contractor) (Signed)- a '---- � Ci------------------------------ � �+ , p Y� -------------------------------------------------------------(Title) 1-1-m- ��r (Plot plan, sh ng size of to+, location of ys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATE--�-------------------------------- ----------------- ---- ------------------------------------------------------------------------------- REVIEWEDBY-------------------------------------- --I --------- --------------------------------------------------------------------- DATE _z------------------------------------------------ BUILDING PERMIT ISSUED------------------------ ----------- DATE......... - Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ----- --------------------------------------=------------------------•-------------------------------------- i. , --- -------------------------------------- ----- - ------------ Date------------ - /� �- ------------------------------- ) FINAL INSPECTION BY:__-.-�`�1--------------- -- - �.--� ------- f SAN JOAQUIN 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 B-51 Revised W-2100