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APPLICATION FOR SANITATION PERMIT Permit No. �� 1✓ '� II� (Complete in Duplicate) Data Issued Application is hereby made lo 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.,544. Ili JOB ADDRESS AND LOCATION-------T- /__---- -----_- -/ aft-. -QrC1-'-.----------- =-, -a- ----1--- Owner's Name________________ --`-�--A---------14-4-11--------------------------------------------------- - -------------------------------------- Phone--•------ -•-------------------.... 7 Address.--- ----------- �-- ------------ ---- ---------•----------------------------------------------- Contractor's Name--------•-- �� -- � Phone.---i y Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [I Motel E] Other E]Number of living units: _[-- Number of bedrooms ___ Number of baths __!____ Lot size ---------�F....... L` '�'_ _______________ Water Supply: Public system Community system E] Private ❑ Depth to Water Table ' �_ ft. i Character of soil to a depthl f feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ .i TYPE OF INSTALLATION AND SPECIFICATIONS: _ �(No septic tank or'ceksspool permitted if public sewer is available within 200 feet.) tic T k;,/C Distance from nearest well_________________Distance from foundation--------------------Mater'sal-----------------___________________--_-._______- yl /r w 9 No. of I`ompartments----------- -------------Size-----_-------------------- ---Liquid depth---------- --------------_Capacity--- "� �� DistanceF from nearest welL__ry4 Distance from fcundation___j�_______-_Distance to nearest lot liwt;P� --------- Number'i of ________Numberof lines---------f_-----------------------Length of each 1^ Width of trench -- --------------------- s os i Type oflifi{ter mate ria l____�Q_C�-___Depth of filter material____�t�------------Total length____ ________________/,_--_- ,SVill Number` to nearest well__/-06 _-r___Distance f m fo ndation----/62___-___..Distance, to nearest lot iine�_�'�____________ Cef P Distance of pits--- --- ------------ Lining material---_- _ -_Size: Diameter__- �----.-.__-Depth---�.,5_______------------- g,}� Cesspool: Drstance from nearest well_________________Distance from foundation------------------- Lining material----------------------,_______-____. -� ❑ Size: Diameter------------------------ ---------Depth------------------------------ ------------ --------Liquid Capacity_----------------------__f_gals. Privy: Distance from nearest well---------------_---------------------------------Distance from nearest building_______________________________________._. ❑ Distance to nearest lot kne------------------------------------------------------------------------------------- -------------------------- Remodeling and/or repairi I� (describe ' r ------- r W y • _ I ^� 1 ------- ----- - ----- -- - - ----�-I--�+--"--------�- - ---- ---- --•--- ---. . _ �'/--- - - "'��------- -------------------------- y Y ------------•--------- ------------------------------------------------------------ I hereby certify that l have repared thi pplic ion and that the work will be done in accordance with San Joaquin County Y ordinances, State laws, an& s -n egul ions the San Joaquin Local H Ith District. wnr and/or Coac(Signed)------------------------- -- -------- ...... --- - mtor) Sy:-----------------------------'1------------------ --- ----- - --- ------- - ------- ---------------------(Title) - - --- --- - (Plot plan, showing size of lot, location o system n rela ion to well , uildingS, etc., can be placed on reverse side). q FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYik Z7- ------------------------------------ DATE REVIEWEDBY 11. ------------------------------------------------------- DATE--------------------------------- BUILDINGPERMIT ISSUED'--------------------------------------------•- - ---------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations;------------------ ----------- p�.. ----------------------------------•--•---------------------•-•----------------••---------- _______________________________________/ ----- --------- ,- '___ __ ___---- --________.___________-_____---.--.__--.------.-_-______-___--__.______._________--________ ---------------------------------------------'- ---------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------...--------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- ....... --- - a �g_ FINAL INSPECTION BY:�_(T....... Date "---------. I SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street, 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1" Lodi, California Manteca, California Tracy, California M ES---9=2M . Revises 1-57�F,P.CO.