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JOY /TyAPPLICATION FOR SANITATION PERMIT Permit No. ¢.......--z (Complete in Duplicate) /4lzi Date Issugcl,-z•� - - - Application is-hereby made to the San Joaquin Local Health District for a-permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549. Orr t s / ' JOB ADDRESS AND LOCATION------ �„� ISI= XI/0—. -..._ - - - PhoneOwner's Name---------------�- Rr-- Address.................-----=----- � ----- �"7 ------------------- -------------------------•------------=--•---,---------•---------------- Contractor's Name-------------------- /c:�iu ` �. � ---------•---•---- Phone_ , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: _/_ __ Number of bedrooms -------- Number of baths _ _ Lot size __:___/c�ll__X'__ _A __j___________-____ 3 Water Supply: Public system [� Commuh'ity system ❑ Private ❑ Depth to Water Table d ft. Character of soil to a depth o 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes] Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E:1 No FHA/VA: Yes E] No ' e TYPE OF INSTALLATION AND SPECIFI ATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ptieyTaa.l t^ Distance from nearest well--------------- Distance from foundation--------------------Material------------------.______._______________.____- ?o No...of'compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- P,os%;�I iibV: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-----=__-____.__- Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material--------- --------------Depth of filter material----.-----------------Total length------------------------------------------ See 'P.�t': . Distance to nearest well___ ___Distance f om'foundation_._�1/G.et' _.Distance to nearest lot line- ., Numb of its______. ._._________Linin material___�� f�5ize: Diameter___.,�_�:�r______.De th_--- �� ./ P 9 PJ 1 Cesspool: " --"Distance,fibm nearest well_____________°:__Distance from foundation-------------------.Linin material--------------------------------------- El ----- ---- -- ---- --------- ❑ Size: Diameter--------------------------------------Depth------ - --`------------ -------- ------.-------Liquid Capacity----------------------------gals.a Privy:,_„-, _ —-Distance,,,,Distance fromynearest yell-------------------------------------------------Distance fromnearest building------------------------------------------ ❑ Distance to nearesHot line-----':--- ------------------------------------ -------------------------------------------------------------- Remodeling .and/or,r:epa•iring (describe):___ r -� __. �. ._._____-�.:- _____ �_ R { ----- - --------•��- :_------- U -= _ -_ ` �_ Y ------ --`_-----�� --- ~-�-------� i - l -------------------------------------------------------------------------------------------------------------------------------- ---------1 I hereby certify that I have prepared his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ti5K of the a Joaquin Local Health District. (Signed)------------------------------------------ --------------------------------- (owner and/or Contractor) ey:... ; -- -------- (Title) �� c -�. ''r` (Plot plan, showing size of lot, location 'of system in elatian t,SZlls, buildings; etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.__-__ I -� -- - --- ---- -- - '�'�'u"-�-------------------------•-------- PATE----1 Q12�/='-6----------- -------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE---------------------------------------- -------------- BUILDINGPERMIT ISSUED----------------------------------------_------------------------------------------------------------ DATE--------------------- Alterations and/or recommendations----=---------------------------- -----------------------------------------------------------•--------•----------------------------•-•-------------•----------- ----------.--------•---------•---------------------•----.---------------------------------------------------------------------------------------------------------------------------------•----------------------------•--.... FINAL INSPECTION BY:------ Date--,7- ------ '�a-- - r 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 E5-9-2M , Reviseo 1-57 F.P.CO.