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V4 2, e_g� Permit No- --------------- APPLICATION FOR SANITATION PERMIT ------- Date Issued --- (Complete in Duplicate) gA plica-�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. Ine- 17-71 JOB ADDRESS AN R LOCATION--- 712, - --- ---- -_ -------------x -------------------- Owner's Name. ----------------------- ---------------- -------------------- -------------- Phone------------------------------------ Address---------------'7------------- - ------------------- --------------- ----------------:W--------------------------------I--------------I------11 . Phone------------------------------------ Contractor's Name------------------go Installation will serve. Residence F1 Apartment House ❑ Commercial Mailer Court E] Motel 0 Other [I Z Number of living units: Number of bedrooms : Number of baths --Z.- Lot size . ....... ------------- A------------------------------ 0 Water Supply; Public system Be*Community system 0 Private E] Depth! Water Table f t. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [_1 Clay Loam [3 Clay E] Adobe 8- Hardpan E] Previous Application Made. Yes El No R__1\1ew Construction: Yes 0 No 99,— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 9 f -Ve Septic Tank: Distance from nearest well--) stance from foundafion_h --------M 27 al No, of compartments---0 , --- -----------size_SX -----Liquid. dep --------Capacify__,-,?-;X0--- d, 17,0 or Disposal Field: Distance from nearest well-A07.— - Distance from foundation--- ----011---- ------Distance to nearest 1.9f line----s------------- -h. ------------ Number of lines.-------/--------------------p Length of each line---- ':_0 ------------Width of tren, __ 44'.A , ---Depth of filter maferiaI__.&_"d Total length-----. -------------------- -j Type of filter miaterial-/-ow .7-4 #� -"— Seepage Pit: Distance to nearest well-" '-'2" orn t9unclation-40--'o.......Distance to nearest lot line-".---- 1k _401.0------- ----- :i T - e - _----Depth.... Number of pits.---_-/-------------Lining material-- ___*7. •*'--.-Size: Diameter_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------.--.-----_--__----_. (� ❑ aterial------------------------------------- ElSize: Diameter------------ -------------------------Depth-------------------------------------------r-------Liquid Capacity-------------------------_gals. Distance from nearest weil... . -------------------- --------------------Distance from nearest building--:----------___-------_-__---.-----.-.-. Privy: -' ' - Ir I El Distance to nearest lot line----------------- - --------- ------------------ ------------ ---------------- ----------------- -------------- --------------- ----------------------------------------- Remodeling and/or repairing (describe):--------------------A-------------------------- --- -------------- ------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------�f------------------------------------------------------------------------ ....I---------------------------:-----------------------------------------------------------------------------------------------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 H--ealt District. Vic,% --- -r -------( r- Contractor)(Signed)------_--------- ------ --- ------ ----- --- -- By:--_------------------_ ------------ - -------------- ----------------------------- ------{Title)-- ---- ---- ---------- (Plot plan, showing size of lot, I tion of system in relation to wells, buildings, etc., can be placed an reverse e). FOR DEPARTMENT USE ONLY - - -------------------------------------------- APPLICATION ACCEPTED BY--- --------- ----------- DATE :-_...DATE_ REVIEWEDBY--------'---------------------------- ----- - --------- DATE--------`--- ------------------------------------ BUILDINGPERMIT ISSUED------------------- ---------------------------------------------------------- DATE------ ------- __r................................................. . ..... . Alterations and/or- eccrrrjmendafions�'. ............r,�........... -------------------------------------------------------------- ... --------------------------- - ------ ------- ---- I--------------------------- --------------------------- ------------------------ --- ----------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------ --------------- ----------------------- ------------------------- ------------- ---------------------------- -------------------------------------- ---- ---•---------------------------------------- ----------------------- ---------- ------------------ ------------------------------- __C� FINAL INSPECTION BY:.9,,?_s----------------------------- ------- Date----- --- -------- --------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT % 130 South American Street 300 West Oak Street Y 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWCOD