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tf APPLICATION FOR SANITATION PERMIT Permit No. _ .. 7.. (Complete in Duplicate) Y4 Date Issued -----f-�'-- 1- �-- 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_________ I ----- -_-- "�--------- -� Owner's Name--------- -- - J _--- "Ply! ------------------ ------ Phone,_.-.- ----------- Address------------------•------------- -- Contractor's Name____ ___ 1.1�• •_S�_:. r�- {� _`�_,,_.L- ---.-- - -- f.--------------------------------- Phone- ---------- _-_- ---- Installation will serve: Residence Rj/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms Number of baths Lot size --------- Water Supply: Public system Community system ❑' Private ❑- Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe, - ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pu6lic sewer is available within 200 feet.) optic Distance from rieare t ~ r ' well'""-""'"ADis'tance frain foundation____________________Material_-_" '_ __ No, of com a tnnents-- ---- -- --- ----Size---------------------,.---------Liquid de ,th--------------------'----Capacity------------------ p 1 - - - q � sposa I e d: Distance from nearest well____ Distance from foundation___ _ . Distance to nearest'lot lin Number of lines______ __ f_� �__r Length of each,e hne �_ ---.Width of trench.f_. _.5__` --'---------- Type of filter materia_____ -s _---Depth o t material_ ---------____Total length _Q r ____________________ 5 "nc Distance rom foundation's .� Q Seepage Pit Distance o nearest welL___ __ _ li�:..___.Distance to nearest lot line_""__'__-._.___ [ Number of pits--- ---------------Lining material-- -____--Sizer,{Diameter-_- `t____.Deprth_r'-_- -------____-- t f - - - f ---------- Cesspool; Distance zea Diameter nearest well=-------- -----Dep+Ince from foundatn_ 'Lining material-------_----------------------------_ F j Liquid Capacity'---------------- ---gals. \ Privy: Distance-from nearest well-- _______:__-_ �_._ I"""- Distance from nearest building________________________"__-__-_ ___._ ❑ Distance to nearest lot-line- ____________ _ Er._....------ - ------------------------------- ---f �,� Remodeling and/or repairing,(`describej:----------------------=-----"----- -•� ;--- •-•-- - •-•--- -•--------------_---- --------------------------------------- ---------- -_- ' '► ' ------------;-------------------- :. -----------•-------------------'=�-------�---------- 1 �� ----------------------•-------------- -------------------- r° .'+y�., ...�... •--- •_.._ r I hereby certifyJhat I have prepared this application and.that the.work will bed nein accordance with SaniJoaquin County ordinances, State laws, and rules and regulations of the San Joaquin L(;U Mealth District. f , DAY. & NIGH` yew � h,gne E#'TIG-.. "R�lhlE _:S-ER1C1-CE----------------------: `-` ' - „___- -contractor D5 E. Miner Ave., -y Stocicton.5�Califs _, �_ - d 'mss-- A Title (Plot plan, showing rEtit, 67 ib of system in relation to ells, 6uildings,.et ., can 6e placed on reverse side). i 1 FOR DEPARTMENT USE ONLY .{ APPLICATION ACCEPTED BY-------• - --- •---------------------- --------------------------------------------------- .' DATE_, =_. `� ------- ------------------- REVIEWEDBY-------------------------------------------------------------= ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----a3----------`------------------------------- ------------------------------------- ----- DATE------------------------------------------------------------- - Alterations and/or recommend.d4bris:------ ----------------------------------------------------------------- -------------- - ------�--'" ----------------------•-----------------------------------""---------- ------------•-------------------- •---------------------------- t ------------------------------ "s-E �`j`�` � ------------------------------------------ - ------------ - ------- ----- FINAL INSPECTION-BY:--,- -----------------7. Date------ ------------ --------------------------------------------------------- SAN --------------------------------------------------• --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 914 North "C Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M . Revised )-57 F.P.CO-