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APPLICATION FOR SANITATION PERMIT /A (Complete in Duplicate) ate Issued JIM-7 A I T�plication is hereby made to the San Joaquin Local Health District for a permit to construct nd install the work herein described. application is made in compliance with County Ord o..5 9. f 46 JOB ADDRESS AND TION-------- ---/V/U/ --- ee Owner's Name---------- R'Je_".,j------------------------------------------------------------------------------------------- Phone-------------------------------•---- 4��_j Address evw _. _e,-a--—-----------------------------------------I.,---------------------------------------------------- ------ 19-------- eell---I — Contractor's Name----------------------C' ..,!p-7)- -----------orl_"_? -,I-e--je.,---------------------------I------------------------------------ Phone)A,�dll/ Installation will serve�'-Residence Apartment House [] Commercial 0 Trailer Court [] Motel—EI—Offier ❑ Nuniber-of living units: ___1___ Nvmber of bedrooms -2, Number of baths __/---- Lot size --------------- Wafer Supply: Public system Eg-'Community system E] Privafe.E] Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ 3vel E] Sandy Loam E] 'FR y C Loa_m,0_Qjpy E] Adobe a-114ardparl I—] Previous Application Made: Yes 0 No Eq-'_ New Construction:` Yes 0 A/ A: Y es El No El TYPE OF INSTALLATION AND SPECIFICATIQNS: (No septic tank or'cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from nearest-well__.._C7------Distance from foundation_-/a------------Maferiai_z% -----C........................ Gill No, of cornpartmenfs---";2—-------------- -- --------Liquid --------Capacity___ ----------------- % e Disposal eld: Distance from near esf' Distance from foundation----14----------Distance to nearest lot line-47-.--------- Number of lines---------- ---------------Length of each line_____1�11---------------------Width of trench. _/4_ `/--------------------- Type of filter _______Depth of filter material--. _ _____-_Total 16rigfh----- -------------------------- Seepaif: Distance to nearest well-----C,2-----------Distance from foundafion--/.-O .. ..........Distance to nearest lot line-45E------ - ----- 1371, Number of pits-_-.)_____-_________Lining material---ro-CJr-___--Size: Diameter-----&-?........Depth_—A-_------------------------ 'N" Cesspool: Distance from nearest well------------------Distance from foundation----------------------Lining material______-__________-_______________. ❑ Size: aterial-- ------ - -------------------------- Size: Diameter--------------------------------------Depth---------------------------------------------------:Liquid Capacity----------------------------gals. Privy; Distance from nearest well---------!----------------------------------------Distance from nearest building________________----_---___-------_______-- ❑ Distance uilding------------------------------------------- Distanceto nearest lot line---------i-------------------------------`------------------------- ----------------------------------------------�:----------------------------- ---- ---- --- --------------------------------- Remodeling and ---------------- ./or repairing (describe): ----------------------------------------------------------------------------------------------------------------------------------r---------------------------------- --------------------------------------------------- ---- -----------------------------------------------------1----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ --------- --------------------------------------------------------------------•------------------ ----------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and fhaf'fhe work will be done.in accordance with San Joaquin County ordinances, State laws, ands and regulations of the he San J,/quin Local Health District.,. (Signed)----------------------- - - --------- --- ---- ----- --- -- - ------ -------- ....... ...------ ---------------{Owner and/or Contractor) ----------------(Title)-----9- --------- -By----------------------- ----------- -- -------- (Plot plan, showing size 0 locat in of system inr afion to wells uildings, etc., can be place on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -------- -------- -------------------------------------- DATE---- ----------------------------------- --- REVIEWED BY--------- ----- ------- - ---- ------ --- ------------------------- DATE---- - ------ ----------- -- BUILDINGPERMIT ISSUED---------------------- ----- --------—---------- ------------------------- DATE-------r------- -------- ----------- Alterations and/or recommendations:------- -- ---- -- -- ------- --------------- ---------------------------I---------------------------------------------------------------------------- ---------------------------- --------------_ -7j ----.-__ -------------------- ----------------------------- a--------- > -------0'---------------------- ------------------------------------- -------*-------------- .......----------j 7_ �_'_T_ J.......... ------ ------ ------ I ----------- ----- ---------- ---- --- ------ -- ----- ----- ----------------- - -------------- ------ Pt^ ------ --- - ------ % -- ---------- -- ------- -------------- ------------------------ -- ---4 - - --------------- ---- ---- ------- - ------- -------- -------- -- - ----- - Date---------- -- ----------- - -------------- - ------ ----- - FINAL INSPEC - - - ------K SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.