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Permit No.,_._i�.rZ. J.Z. D APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ________/.s.A______ nT�plica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. �V JOB ADDRESS AND C ION...... ------=�- ' ''``-- --------------------�— Owner's Name------------- •------•----------••-f3-- --------- -------------------------------------------------------- Phone-htV--•.1 7 f Address........................ =---- .7------•- - ------- -»-•----------------------------------------------••----------------------------•-•- Contractor's Name -�--- �(� ---------------------------------------- Phone---[kT0----(---� �7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ Number of living units: ____Number of bedrooms ---7Number of baths __ - Lot size ---40Q Q__1___?C,.___. - Water Supply: Public system Community system [I Private F] Depth to Water Table ft. \(� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B"Hardpan ❑ �) Previous Application Made: Yes ❑ No P-1' New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / �^-��---a �9• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e is Ta Distance from nearest well_________________Distance from foundation--------------------Material____________-______-__-___________-_:-__________- ,.�.� No. of compartments--------------------------size--------------------------------Liquid depth----- ------------------.-Capacity----------------------- s�F . Distance from nearest well---------- ------Distance from foundation--------------------Distance to nearest lot line_________________ Number of lines___________________________________Length of each line----------.-------------------Width of french__________-_________:_-____________ C. Type of filter material____- __- _________Depth ofaterial,. _ _ ---------Total length------------------------------------------ Seepage Pit: Distance to nearest well- __Distanceyfr � ation __�S---------Distance to nearest lot>line___` ____� Number of pits..... __-__._-___Lining m erial C -_J_ Size: Diameter.-.32...........Depth_-_. 4-__'e______________ Cesspool: Distance from nearest well_________________ istance fr oundation--------------------Lining material-----------------------_________...... ❑ Size: Diameter--------------------------------------Dep ----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------......... ❑ Distance to nearest lot line---------------------------•-----------•------ ---------•----------•-•--••-------•--------------•--------•------•---------------------------- Remodeling and/or repairing (describe):------------------------------------- ----------------•-•-------•--••-----------------•----------------•-----------------------•--•-----•------•-------- ---------------------•----------------------------------------------------------..----•----------------------•---------------------------•--------- ------ ------------------------------------------------------------------------------------------------------------------------------------•----•--------------------------------------------------•-------•-.-.-------•------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereb that I have prepared t is application and that the work will be done in accordance with San Joaquin County ordinances, to la s, and rules and regu) 'ons of the San Joaquin LocalCHealDistrict.Si ned _C�✓�'�-! `^ --------- C" -- - ---- _ Contrectorj ( g )-------- By:---•------------------•-•-----------------------•----------•------------ -=-------•--- --- - - --- (Title) = = , bm (Plot plan, showing size of lot, location of system in r ation to a s;1 buildings, etd., can be AceJ on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY'..` ---- ------------------------------------------------------------------------------- DATE_ ................................................ REVIEWED BY DATE_.. - tf� BUILDING PERMIT ISSUED........................................................................ ----- DATE.......... VI •--------------------------------•------ Alterationsand/or recommendations---------------------------------------------- --------------------- --------•---___-------------------------________--•---•-------------...................... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------..-----------------------------------•--••-_---•-- ............................................ -•-----------------------------------------•--------------------------------------------------_._._-._-.---------------------•----------•------------------------•--•------•--•-- ------------------------------------------------- -----•--------------------- -----•--------- ---------------- ----------•--------------------•-----------------••--------------------•---•----------------------•-•---------- -------------------------------------------------- ------------------------------ ---------------------------------------- -------------------------------------- ---------------------------- ....................... FINAL INSPECTION BY:.< `--------------------------- ------------- Date.....� - -7"- �� ------------------------- 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, California E5-9-2M 145446 ATWDDD 12-54