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APPLICATION FOR SANITATION PERMIT emit No. A (Complete in Duplicate) �• -�w -- Date Issued Applica{ion 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 Ordinan e No. 549. I / JOB ADDRESS AND LeTION.._____..�D.�`=---- - � ------------------------ -----Owner's Name ------ - re."q'.:-�-- — = ------ Phone Address �zr -------•------ ---- --- ----------------------------- ---------------------------------- ----------------------•--- ---••----- ----- p� F Contractor's Name----------- = - Yk`` •----- --�- ---T,-------- Phone- _ -----•--2 . Installation will serve: Residence �Apartment House E] Commercial (ITrailer Court E] Motel ❑ Other [] Number of living units: ---/_ Number of bedrooms __9__ Number of baths . ___ Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3-feet:° Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ElClay ElAdobe[..Hardpan El Application Made: Yes E] No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Tank: Distance from nearest well_________________Distance from foundation-------------------Material------------- No. of compartments----- ---- -- ------------Size-, --------- ________.- •-------Liquid depth------------------ C . apacity----------------------- D13r, al F'e1 : Distance from nearest well_...____...__.__Distance from foundation----------_--------_Distance to nearest lot line----------------- �.F:�--- Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------------�-.- . - --------- ype or filter material-------------------------Depth of filter material---------.-------------Total length------------------------------------------ - Seepage Pit: Distance to nearest well_ _ . _____Distance m f undation___- -___.---D•st nce to nearest lot line-;;- Number of pits..__--------_______Lining material__._ _.i_�__.._Size: Diameter___ --��.---_Depth__ � Cesspool: Distance from nearest well-----------------Distance from foundation-----_------------_.Lining material__.___.._--_-.____________-__._____. ❑ Size: Diameter---- ----------------------------- Dept h--------------------------------------------- -----:Liquid Capacity -------- -----------gals. Q Privy: Distance from nearest well--- -----------------------_-----------------.----Distance from nearest building------------.----------------------❑ Distance to nearest lot Remodeling and/or repairing (describe)--- ------------- --------------------- --------•-•--------•---- -•-•--------------------- -- --- =-----------------------••------------------•---------•-----------------•---------•--------••---------------= --------------•--------------------- -----' ----------------- f.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 Joaqu' Local Health District. DAY 4 Iii E41' (Signed)--------- _Selatic..T_art!e"SeryiZe------------- •-- --------A)-------------------------- ------ �C r Contractor) 1206 So. Eldorado HO Z70{"J- By: o Sttwkt---;-�-Tif :- --- f---{Title)---- -- ----- � - � - (Plot plan, showing- size of lot, location o sy0em 1n relation to w s, buildings, etc can be placed on reverse side). r :1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- ----------------------------------------------- ------------- ------------ DATE Z-_ ------------------------------------ ------------- VIEWEDBY--------------------------------- -:--- - -- - ------------------------------------------------------------------- DATE__.. --BUILDING PERMIT PERMIT ISSUED_.. -------------------- -------------------- ----------------------•---------- DATE-,.-'- 9-1%--------------- --------------------------------- Aterafions and/or recommendations_________________________ -------------------------------•-- ---------------------- ---_- ---- ---•-----•--------•--------•------•-----------------------••-----•--- ...... �- =-- ------------ -- ---- ---- - ---------------------------------------------------------- .--------------------------------------- FINAL INSPECTION BY:. cc 3 --- --------------- Date..... " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9 146446 ATWODO