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\�,,\; n /7A-- APPLICATICZ4 FOR SANITATION PERMIT Permit No. _A17`.Q_... ( V O (Complete in Duplicate) Date Issuedl Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance Ao. 549. JOB ADDRESS AND LCATION..... .� a—------ V `•�C ed7b4-------_-_---- Owner's ------_- ---Owner's Name------------ ----------------------------------------- -------------------------------------- Phone .._ Address---------------------- -------------- ------• --•--- ----------------------------- _.... Contractor's Name____ 0 ----------- /�J Q 1 fig . * 1��'., Phone ..�!` Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other,AO,cuft+' Number of living units: __ -_'Number of bedrooms _ Number of baths _- Lot size ___- ....,tC.___,• �"--------- Water Supply: Public system 19-1sommun'ity system ❑' Private ❑ Depth to Water Table _490 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑: Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe[g- Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No W,--MX/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sis Tank: Distance from nearest well-----------------Distance from foundation--------------------Material__-___..___.___-_______-_____:_____-_.._----___. No. of compartments---------- ---------------Size------------------------•-------Liquid depth--------------------------Capacity------------••-•-_----- osal d: Distance from nearest well (,i Distance from foundation__f 0.-..--_..Distance to nearest lot line _lq_�___ Number of lines_____!__ ____.•____ .-_ __Length of each line___- '.._C _--------Width of trench-_ �" Type of filter material_ _Depth of filter material_-_-_ ________Total length___:-_� ___................. S age Distance to nearest well ! n� ___Distance m f undation___)A�`___ Distance to nearest lot line Number ofp-ts-_•�-.___--_-__ Lining material:__ � lunclation _---Size: Diameter----�-.�="_..Depth__�:•�_' ,-_-•- C:esspool: Distance from nearest well_________________Distance from --_.--__-___.___-:Lining material----------------_._-._._.____-._._._. ❑ Size: Diameter--------------------------------------Depth----- __ ________________ _-.___ _-_-___..Liquid Capacity gals. C� Privy: Distance from nearest well--------------------------------- ---- :_-. _Distance from nearest building---•----------------------- 171 .____- _.______❑ Distance to nearest lot ------------------- ----------------------------------- Remodeling ---- ------------------------•Remodeling and/or repairing (describe):------------------- _ - -- ----_- ----- - -...-.--..------l------ ------ jL.-. . --•- ----__ __...................... .......... 4Lr -------•--•- ------------ - ------•-------------------•-----------•---------------------------•------•----------------------------------- -----------------------------------------------------------•------ 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 Health District. (Signed) � T -lLc; ---- ---- -----------------------------------------112111V Contractor) By:..........--------------------------------------------------------------------------------- ------- -•---- ----------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to s, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__1 DATE S - REVIEWEDBY---------------------------------------------------------------------•----------------------------------------------------- DATE-------------------------------------------------- BUILDINGPERMIT ISSUED..............-----------------------------------------------•_--_.-------------------•-------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------------• ---------__-- j.•----- -_-.---,._._.. - __. _-- ----- ZZ -- PJ4� --•------1/Y�'�� . - ........... ��-------------�_b _._..------••-••-••-••••----•--••-••--•-- . - t-QNB. '- -f D----------- r:Tf: `r0_0-------- �+ --- KAQ,e_.1-.---------- Q---------MAK F ------- Il�S ��_.�-� --------------- ----------------------------------•.. .- - ----- FINAL INSPECTIQN BY:. Date-------- / -- ---------------------- SAN --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M - Revised 1.57 FY,CO.