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APPLICATION FOR SANITATION PERMIT Permit No. .___/.... .�/.. ..: : k � (Complete in Duplicate) y _ Data Issued ,! Application is hereby made 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--=--•. l . ...... ------ .------ ------- - Aw6z�L- a> Owner's Name _ -- -_------------------ Phone--------- Owner's ........... ... . x .-•------------------ - • .................. tF Contractor's Name Pho -2 Installation will serve: ,Residence { 1Cpaftment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑� - } Number of livi.ng'units .:i.� Nu•mb�'of'b,pdiooms��NumbO o#'6ath _.::. L'ot ize`.___..._ -_., . . ....... -__---- Water Supply: Publics stem ❑ Community stem ❑ Private'❑ Depth to Water Table��t. Y � Character of soil to a depth of 3 feet: Sand I.-�G evahp❑ Sandy Loam C] Clay Loam ❑ Clay [j Adobe Hardpan ❑ Previous Application Made: Yes No Neai' tt'ts�tion: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE-OF INSTALLATION AND SPECIFICATI(*S: (Na septic tank or'cesspool peivnitied if public sewerir'evallable within 2Wfedt.) . . i e tic T Distance from nearest"`wall____::...________Dis#ance fiom foundation...................Material ....-.__.......... ............ No. of compartments al Fie com artments.............F'------ -••-Size-•----._ ..-- -- Liquid �Pt ...............Ca au Distance from nearest well---- -----------Dstance-'„w iW om foNndation. :... _. . ..Distance toneerest lot line................. Number of lines--------------------- ------------Length of each line..............................WEdth:of trench...-------------•------........... . Type of filter material.____._.___:..__-_____.Depth of filter material. ............Total length............................................ k Seepage Distance to nearest well._ _ moa .Distance m oundetion .,.....D�stanee�a nearest lof.line-._..`A0_.._ diameter . Number of pits----j-----------------C,,ning materiel__ CX. ...Size: ��.!�'=-..bepthoZ.�______......--•-----• Cesspool: Distance from nearest well__I-------...__-;B`rTtvand atiort`7^` .___.Lining material................................... ... ❑ Size: Diameter------------------...... ...........Depth..................- -------- ---------.--•-- ._..Li uid Ca aci els. \ 9 p tY------------•---------------g Privy: Distance from nearest wel .....:......... ........................:::.•__Di- ante from dearest building.__..___._.___.__________.____.._..___.._. Distance to nearest lot lin ' f -•---•--•---.....L--.......................................... ,.��.. , t Remodeling and/or repairing (describe): t t i-------------------------�------•----•-----------•..... .....................:....................... I ---------------------- --------------------------------------------------• --•---•----•---•••-- I hereb a fy that I have prepare application that the wo will be done in accordance with San Joaquin County ordinances laws, end r s end re tions of the Sa oaquin Loc Heal+h District. r (Signed}_.. 4 ( n ctor) Co a gY: --------------------------•-----•-•---•---••-•-------------------------------- -• ••----•--- (Title)• (Plot plan. showing size of lot, location of system in relati o wells, buildings tc., can be placed on reverse side}. _ I FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY• ---------------------- --- DATE:-----f-----•-----•... ......._ ................. BY-------------------------------------- --- --- � DATE..... -� ` --..--.--------•------.....------- BUILDING PERMIT ISSUED------------------••------- �� — ........._...... DATE.__. ..... .. . . .........7-4 ----------•------------------------------•-------- -- , Alterations and/or recommen Ions•.__.___A �_________________________ -------------- ., .u1�i- ' `.............. rrf ` --------- --------------------------------------- ---------- ------------- ------.. ...._ t--•----- --� -- -------------------------------------------•---....................................................................... ' rr FINAL INSPECTION BY: :... Date L- -- -.r✓.. - 7------------------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street f Stockton, California Lodi, California Manteca, California Tracy. California 1: f ES-9-2M Reviseci 1-57 F.P,CO.