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11 APPLICATION FOR SANITATION PERMIT Permit No. 1711........... y (Complete in Duplicate) T� Date Issued __�__�__�___. Application is hereby made l'to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION..._ S� =' y,�04 � � or Owner's Name.... lis?J_'_ _t--- -- ------ -- --•- ----- - - Phone.-.-,- _/ ----- Address ----.- 1l, , Address----• ----- -- --- - ------ --- -- --wj��_JI--------------------- ,w rl-., ��W Contractors Name ---------- = Phone 7i L Installation will serve: Residence ;Apartme House ❑ Commercal ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�___ umber of bedrooms off._.. Number of baths __�____ Lot size _________ _ ......................._ Water Supply: Public s ste'sn Com' m'unit s stem Private. Depth to Water Table ________ ft. Y Y Y ❑ ❑ P Character of soil to a depth'iof 3 feet: San E] Gravel ❑ Sandy Lo:�PNO Clay Loam E] Clay E] AdobeeNj Hardpan E]Ali Previous Application Made:. Yes E] No [v�New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) lu- d Se tic T 'k: Distances from nearest well _.- Distance f foundati�iquid epth Maeril__ =_ .C__ ________ ________ - d p T ---- No. of com artments _..--:-----' - ---5 d �- -- opacity_-- -C7_-- { tte� r . it / Disposa ield: Distance from nearest well----b5DaDis" ii �om fos}n;dation-lP ______..._Distance o riea'rest lot line---/_Q....... Number rIoi lines_____ ______ _____ ngth of each line_____-?f_ --_--.-.Width of trench-__121 !' Type of filter material__ .. < _Depth of filter material_-.'_�_ ____________Tota! length_._.__'_�__ _ ___________________ iii to nearest well___< -------- Distance rom"foundation___ ___-_----- Distance to nearest lot-line--_'_�_____--- Number of pits- -------------------Lining material--.- �_..� Size: Diameter__ ___.__..Depth__._...__ �__ -__..._-_- Seepage Pit: Distance Cess o l: Distance p '" from nearest well-----------------Distance from"foundation--------------------Lining material--------------_-------------------_-_. Size; Diameter---------------------------- ---De th----------------- "• •----------------------------Liquid Capacity ---- -- ------------gal$, Privy: Distance)from nearest well---------- --------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------------------------------ .. - ----------------------------------- --------------- "_ w_ Remodeling and/or repairing (describe):--------------------- - --- ----- -------- �`�;- `=° ---------------------------- { ---------- - ---------•-------•---------------•---• ---- = - -----•--------• '"��:_--•---•- :• '.•4� - ------- ------------------ ----- ' ------------------------------------•--------------------•-------------•-•-•------•--••----•-----------------•------- ----------------- ------------- ------------------•-----. ----------------=--------------- 'll ------------------- -;,_----------------••------------------------------•--------------------------------------•----------•--•-------------------•------------------------- ;r I hereb that I v, epared this application and that the work will bead"one in accordance with San Joaquin County ordinances, tate laws, an ul r ula ions of the San Joaquin Local Health,District. / r ne --- --- ----------- x. reF- — Si ------------------------ ----------(Owner and/or Contractor) BY: ------(Title}- /-------J-5-61---7.1--4--4------ (Plot plan, owing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). 'r FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTEDIIBY r ----------------------- DATE = '-------- --------------------------------- REVIEWEDBY i'---------------------------------------------------------------------------------------------------- -- DATE----------------------------------- BUILDING PERMIT ISSUED!:--------------------------------------------------------------------------------------------------" DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- ------ ------ :- • ------ ----------------------------------=---------------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------•-•-----------------------------•--------------------------------------------------------- -----------------------------------------------:1......... -------------------------------------------------------------------------------------------------------------------------------- -------------------------------- ;'�_ -----•-----------------------------------------'°----------•---------------------------------------------------7777-- --;=-------------------------- -- ---------- ----- ---------- ------------------------------------- - -- ----- --------------------7777-- -----•----------- ------ ------ ----------- -------------------------------- ----------------------------- --------------------------------------------------------- --------------- --------------------------- II -- FINAL INSPECTION BY: - ------------ Date. .':---- 3 ON ...wrY t�. ..T� USAN JOAQUIN LOCAL HEALTH'DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore-Street 814 North "C" S4reet Stockton, California Lodi, California Manteca, California f Tracy, California X'" ,1 ES-9-2M 10-52 Revised W-2100