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J1�x-/ / 1 ate, �• APPLICATION FOR SANITATION PERMIT Permit No. . .� ..� (Complete in Q,pplicete) J q Y,re� Date Issued ___- This Permit.. Expires 1 ' From Date Issued Application is hereby made to the San Joaquin Local Healfh,be rict fore permit to construct and install the work herein described. This application is made in compliance with--County Ordinance No. ,W. JOB ADDRESS AND LOCATION____,_._ ---- - ., ...... _----------- .-- -- Owners Name. r r Phone - •------- Address ----_. g ---- -------- - ------------------------------------------------------------------------------- Contractor's ame------ �__._ .�� _:- -------------------------- Phone,.r�____e5 - Installation serve: Resident p r ' rit House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ umb of i�-ttpoms _,Number of baths __ __ Lot size Q. __fP> -------------------- Water ________ ___-_ r�+ Water Supply: Public system Number o living units r�"' ,C® tq sy'�" ,n �] Private ❑ Depth to Water Table ft. Charac#er of soil to a depth of d ❑ ,Gr i ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n ❑ Pre ARplication M : ? o ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes []" No ❑ TYPE OF, STALL [JD SPECIFICATIONS: rt (No.stiff f, "or cesspool permitted if public sewer is available within 200 feet.) ,t pt T nk , Distance frpm nearest well_________________Distance from foundation -_-.Material___--__.__-__.-------------------------- _______-_. No. of cots artments_--__ ___. Size________________________________L� uid de th__-___-__ --_ Capacity P - q P - - ---- - -•--•--•--- Disp Id: Distance from nearestyaell _�A�E...Distance from foundation /e � Distance to nearest lot lin�j_::....... �b Number of lines_ _k _---- ----Lengfh_of each Ime_..__t�.2e_;_.J`........Width of trench.' r -----.--- Type of filter material_____ CI�_____DeVH�f filter material. l�-----------Total length---------LZ�___________________- Y see 'Distance to nearest well .-__-/ .8iN�_-Distance fr foundation.....IV--------Distance to nearest lot line �a__--__-__ Number of pits--------/____------------Lining material___- �.Size: Diameter---- -----._-_.--__Depthc-.7J--------------------- Cess;' Distance from nearest well---------_.._ Bance from foundation_____-__--_--_-_-_Lining material------------------------------ ❑ Size: Diameter--------------------------------------Depth......=---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line----------------------------- ---------------------------- ! - ---------- Remodeling and/or repairing (describe): -%= - - �� / -------- -------------- r� ---- - --------------- --------------- -------- -------- - - -- - ----- - -- - - -- - - ------ - - - - - - ------ ---------------- --- - f ----- --- --- -- -- - - ------- - ------- - ------- - -------- ---------------------------------------------- ---------------------------------------------- ------- --------------------- 4,�' > I hereby certify that I have prepared lication and that the work will be done in accordance with J, aquin County ordinances, State laws r and g at' s of the San Joaquin Local Health District (Signed) -- � - -- -- - - (Owner and/or Contractor) BY: --------------------------- --- Title - (Plot plan, showing size of lot, location of system in relation to well , 'Dings, et , can be laced on reverse side). FOR DEPARTMENT USE ONLY C 09 if 06 APPLICATION ACCEPTED BY. - -- - --- ---- ----------------------------------------------- DATE------- -------------- REVIEWEDBY----------------------------- ----------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------•--------------------------------------•------------------------- ---— DATE------------------------------------------------------------ Alterations and/or recommendations:---------------------------------------------------------------...------------------------------•-•------------------------------------------------------- --------------------------------------- -----------------••-----------------------�-------------- -------------------------•-.---- . ' = ------�------------- --------------------------------------- 001, FINAL INSPECTION B - - ----------- 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-9-2M Revised 8-'59 F.P.Co.