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APPLICATION FOR SANITATION PERMIT Permit No. ...G'41- - (Complete in Duplicate) Date lssuedT._ �161/5-( 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 Ordinance No. 549. JOB ADDRESS AND ._ LOCATION_._ _y 1 ,�`f_�__.. Bu. ---------- ! -/ a----------------------------------------------`-- Owner's Name--------- + CJS.-------•---••----------------------- ----- ------------------- ------------------ Phone.//V__ �-- r Address----------- ------- ------..W---aX--- ------------------------------------------------------------------------------------------------------------- Contractor's Name-----•---------------- _S _/"�:'�sS --------- 107C--y---------•---------- -------------------------------- Phone---,6V---o,5-6-0/-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms --k' Number of baths I--- Lot size ___5577_- 77-_— --- .__-._ � Water Supply: Public system [[Community system ❑ Private ❑ Depth to Water TableQft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ElNo New Construction: Yes ❑ No El,g/,iz9, '/lt � �� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Se tic T Distance from nearest well--,^-------------Distance from foundation--------------------Material--------.-..----_-____-____--___--_-__----__ No. of compartments- - --------------- ----Size------------------------------.Liquid depth------------------ Capacity Disposal Field: Distance from nearest well..---------------Distance from foundation--------------------Distance to nearest lot line----------------- �. � j rj Number of lines--------------- -------------Length of each line--------------------- -------.Width of trench----------------------------------- Type of filter material------- Depth of filter material----- _---------------Total length___.__-._--__.-_____-.--------_-_----_._ Seepage Pit: Distance to nearest well-APn1l---- Distancefro foundation_ -49•"__Distance to nearest lot line---- Number of pits.. - Lining materia � �. --.Size: Diameter-- v�c+�r!. Depth.....Z7 � �d Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- IN. - ❑ - Size: Diameter------------------ -------------------Depth-------------- -------------------------------------Liquid Capacity_------..._..--• -----------gals. Priv Distance from nearest well-------------------_---.--. __...__..__-_bistance from nearest building \(� Privy: g` ❑ Distance to nearest lot line----------------- - ------ ------------------------ 4., 4/ Remodeling and/or repairing (describe]------------ -------- --- -------- •--•------------------------ --------------------------------------•---------------------••-------:--------------------------------------------------------------- ----------- -- - ---------------- -- -- - ----------------------••--------------------------••---------------- _------ _�----------- I hereby ce ' y at I have prepared this application and that the work will�be done in accordance with San Joaquin County ordinances, Stat laws and r les an ,egula+ions of the San Joaquin.Locah�f`lealth District. i _ (Signed)_ - ,�: - - ----- _ _ act F tr. o"r� _ i --- -- BY---------------------- �: (Plot plan, showing size of lot, location of syste ifi_rel do t Ilsbuildings, c., can be placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY,.. DATE REVIEWED BY-------------------i - - DATE--.— ..� -- ------- ----------------------------------- BUILDING PERMIT ISSUED. ° - DATE---------------- •. - --- f' ., Alterationsand/or r ommenda#ions:.---------- ------------ -- ---�------ ----------- ---------------------------- -------------------------------- ----- ----•-•-•-•------------------- ------------ , -------------------•-•-------- -------------------------------------------- ---------------------- ' FINAL INSPECTION BY:----- �� ` - --------------------- Date------ ------- ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, Caiifornia ES-9-2M 145446 A7WOOD 12-54 +.