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APPLICATION FOR SANITATION PERMIT Permit No. __ - ........ (Complete in Duplicate) tf;' 4 - { Date Issued --- 'y°- _�_-- .- �l\` Applica*ion is hereby made fo Ithe San Joaquin Local Health District fora permit to construct an This application is made in compliance with hh7County Ordinance No. 549, p d install the work herein described. JOB ADDRESS AND LOCATION-------------/- --- --- ----------- .... �---- ../ f�/CIt° J------"-__-- Owner's Name-------- ---------&k-iie A/--------- - -----1--- - ------- Phone • . Al �.0j - Address---•-----------7 _1_71�--•--lvO---A RC-4 Contractor's Name----- - vR.R' _j-S h----- Q_1 , ------------ ----------- ---------------------------------------------------- Phone-- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _-_/_ Number of bedrooms A_.. Number of baths Lot size __"/d4.-` Water Supply: Public system ❑ Community system ❑ Private J& Depth to Water Table,�jo- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No WL New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Notance from of compartmentsr._W�_. Sizen5�ce from foundation MaI Liquid depth-.. .�a� ------ �. Capacity Disposal Field: Distance from nearest wef b..�`.- IJistance from founda#ion_.-__.. --..� i �XL_ � DFstance to nearest lot line_ �2,et..___ Number of lines__..__.__ .....Len f each line__.._-_ -- --- - ----- ...---__f_-Width of �} Type of filter material.--rte- _S ON " o filter material---.._1g, -. -Total length-------gip_.. -------------------- Seepage Pit: Distance to nearest well ----- is#a e from founda on-_ r� ?cam` --"- Distance to nearest lot line_.__ ------ Cesspool: _.__ j � Number of pits------_/----------- � ing m riall9p,Ca�__��arneter_._ «' 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 fine.. ____...__,...t____/.----- v Remodeling and/or repairing (describe):--------- -- t( r,` ------------------------------------- ---------------------------------------------------- ------- ----------------------------------------------------- f ------------------------------ ---------•--------- ------------------------ - - I hereby certify t have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State and ru{es and regulations of the San Joaquin Local Health District. {Sigrrtd} ---------------- - --------- -- --------- (Owner and/or Contractor) v J Title------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED _:_-_ +9Z"1§frF_ DATE---- ------------- --------------------------REVIEWED BY - --� �--- -- -=��- -- -- - -�- ------------------------------------- - --------- -._ DATE -----�-- � � : �"�----- ------- -- -- BUILDING PERMIT ISSUED- J` Li L---------------------- -----" -------- ---- - -------- •----------------- DATE--------- ------------ Alterations and/or recommendations_ _________ - "--""" ------------------ -- - ----- --- - --- --- --- --------------------------------------- .•---•- --- ---- ------------- -- ,`sr utJ--.-,G.0 -1 r�(<� -----1----4- .1 --•----••------------- a. f " ,�,l ,� ,.�, cam- � hc�-"'�a .................... -- -- ------_-r-- --------------- FINAL INSPECTION BY:-- ---------- - --- ---- Date--- -------------------- 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 i454i6-Goo