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APPLICATION FOR SANITATION PERMIT Permit No. __D•.�..d-. __ ,[Complete in Duplicate) 1 U1�1 J<(��tit/_.: %`-Ci'4n �1�..•_�... Date Issued Application is hereby made to the San .Joaquin Local Health District for a permit to construct an install the wor erem described. This application is made in compliance with Cou .y Ordinance N 549. ' a--� p l J3~17,.,V!?•c – )`s-e," - ..__ _._ �] '0 --1+ s - `_ 1l� JOB ADDRESS AND LOCATION_._ _.___ _ _.i__ _ ------------- ,---------- Owner's Name---•--- _. /�!�f---- ��/�I__.1—)e.G�.9-----------.---------------------------------------------- Phone------------------------------------ Address .:� Z7.X. .. ----------------------------------- --- -------------- --- -----------------------------Pho.n-:4 `�_77 e-7 Contractor's ------------------------ ------ Contractor's Name-- �� -- ------/ s` – - ---------�-e-._ -� •--- ��' Phone � Q 'f - l' Installation will server Resi ecl nce [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ or Number of living units: ---/_ Number of bedrooms _-- umber of baths ._ ___-_ Lot size ___ _Z !�'--. ---------- Water Supply: Public system E] Community system El Private �epth to ater Table ft. Character of soil to a depth of 3 feet: Sand 171, Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Aclobe4iPtl4ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes O-INo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if Iic sewer is available within 200 feet.) Septic T nk: Distance from nearest welljov Distance from foundation---A2.------- Material--- -- -- ------------ No. of compartments__ ii-___, -.-.....Size. _ ��_ __Liquid depth--- --`�-- p Y- -- ----Ca acit �I?________-- Disposal Field: Distance from nearest Distance fro mof undation__ ' ._...Distance to nearest lot line_______ 97_._77 LH' Number of cines------ ---------------------------Length of each line ��Cf--------------Width of trench--- ---------------- 4 Type of filter material��](._Depth of filter materia!----f_ _`�------Total length---,j .0- __ Seepage Pit: Dis#ante to nearest weU____________________)}__Distance from foundation____.._..___.._.___.Distance to nearest lot'li� �:j E❑ Number of pits---------------------Lining material--------------.-- ---- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation------------.-_.___ Lining material------------------- ._________.______ p ❑ Size: Diameter--------------------------------- ----Depth------------------- ....------------..--Liquid Capacity.............................gals.~ r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line----------------------------- ------------------------------------•---------------------------------------------------•-------------------- Remodelingand/or repairing (describe):--------------------------------------------------......--------------------------------.-•-------------------...._.._..-----------........__..-._._._... ------------------------------------------•---•-----------•------------------------------------------`---•---•-----••-------•---------------------------------------------•--------•-------------------------------------•-- n� ===----•---------•-•------------•-------------------------------------•-•-•------•-•----------------•-••----•-•-------.-----------•-•------•----- ---- 'v -------------------------------------------------- ------------------------------------------------------------------------------------------•--••------------------ -------------------------------------------- I ----------•------------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. rr k - (Signed) .--- ' ..i20--Sop Ido -S HT rui�-704--------- - :---- f --------.--- = {Owner and/or Contractor] By--- -�t1 -----(Title)--- E] [Plot plan, showing size of lot, Io&W0&sj?4#h in relation to ells, buildings, etc can be placed on reverse side). , .... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE__--, y. r �A)2� :! REVIEWEDBY ----- ----------------------- -- ----------------------------------- DATE------------------------------------------Z------------------ BUILDING PERMIT ISSUED--------- --------- --------- --=- --.-:------ �--:------------ ---- ----- --- - --- --------- Altera . .s and/, re mmend ions: `- - - -----------I------------------------------------- ----------------------- ----• -------------------------------------------------------------------- -----------------= -- -- a----------------------- . ------------------------------------------------- J -------------- --------------------------------------- --- --------------------------------------------------------------------------------------- ------------------------------- -------------------•--•----- ' r I, FINAL INSPECTION BY:.._ ll.(: .._ Date_.--1 � --------... ---------------------------------------------- SAN JOAQUIN LOCAL ALTH 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 1-05446 ATWO90 12-54