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~` APPLICATION FOR SANITATION PERMIT Permit No. (Complefe in Duplicate) Date Issued _1171S•�r__. Applica}ion 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..s_.___... _ I' �..__ C�2n�e -�---------------------------- ------------------------------------------- --- - - Owner's Name --- _ r ..t trt¢ - Phone------�----------------------------- '0 0. f Address - ---------•-•----•-- ---------------------- -------------------------- ------------------- _ _ ----------------- ---------------------------- Contractor's Name__. ------------------- -�,"----. --- Phone `� � Installation will serve: Residence [1-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___'2Number of bedrooms __ . Number of baths --el- Lot size _' �- .. -________________________ Water Supply: Public system T__`Icommu ity-system ❑ _ Private ❑ Depth to Water Table 1Q_ ft. Character of soil to a depth of 3 feet: Sand ❑""G'revbl ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: 'Yes ❑l No New Construction:-Yes 2 o ❑ 4 f' 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted'if,public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest well-----------------Distance from foundation__. _'�0_'____.Mater1al._� wt _____ No. of compartmS--._ apacty---[T ,--- __.. Disposaield: Distance from nearest well_ _Distance from'fbu d tion.--1,-!�-."____Distance to nearest lot line-___s "'Length of each''line_�s=-7a-`-7p"/- Number of lme ___.-r_._ ---- -- - -- --------Width of trench.--------_-` -------------_-._-- - --------------------- - - 1 , _ Type or filter materia___ -____Q_(—'_�f__Depth of filter material__- length---- Seepage ength___ o s .. Seepage Pit: Distance to nearest well-'------------ from foundation---------------- to nearest lot line__.___________.__ ❑ Number of pits---------------�___---Lining material--------------;-`_ ----Size: Diameter-----------------------Depth_______._--_-------------__------ r .- Q h 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--------------------------..---_---__-_-_ ❑ Distance to'nearest lot'line--------------------------------- ---- - -----------------------------------------------------_----------------------------------------- � Remodeling and/or repairing (describe)=------------------------------------------------------------------------------------------------- -------------------------------------- ...... --------------------------------------------------- - - - .-- ---------------------- ----- --------- --- ---------------------------------------•--------------------------------------------- ------•----------------------------------- ------- --------------------------------------------------- I --:----------I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinancesps5ft o I ws, qp rules and reg lations of the San Joaquin Local Health District. (Signe( ._ 4�'_ .�r+cr!----+- ----- Own, and/or Contractor (Title)-�------:---..�r�------Kells, -- - •- -r -•---•-----------------._Title __. ��,mf�-?. �..m-- (Plot plan, showing size of lot, location of system ;n relation buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = DATE ------------ --------------------------------------- REVIEWEDBY--------------------------- ------------------------ -------------------------------------------------- DATE. -----------•----- -------------------------------- BUILDINGPERMITISSUED------------------------------------ -•--•--- -------•-------------------------------------------------- DATE --------------------------------- -•-------------- Alteraf ons and/or re mmenda 'ons: tr - s ----- tr --- ----- . . . = Z---------------------------------------------------- ---------------------• -----• '= -FINAL INSPECTION-BY:--l- --- -------------------- ---- -- -------•--•---• 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 { E5-9-2M Revised W-2100