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/ APPLICATION FOR SANITATION PERMIT Permit No. ---4"-: _Y�___-. (Complete in Duplicate) V/?-!.� / Date Issued _- AzW : r77-'(!,?�vr-(E 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. o,e- W ccvr�nci'r'' o JOB ADDRESS AND LOCAT ON___ __ _ , ` Owner's Name__ J IRa -' " -- --[°---- ��' �- 5--_----- Phor"b z , Address 1 ' .. �,� QJ ------- .1-hair-al-_ it Contractor's Name = ' `� . ' � . Phone- /10.- 7 Installation will serve: Residence-❑,,Apartment House ❑ Commercial E] Trailer Court Motel ® Other 4 �`'�'y Number of living unit"s:_----___ Number of bedrooms _______ Number of baths ____ e . ____.___-• s _ ..t t Water Supply: Public!system'❑ Community system'❑ "Private R Depth to Water Table ---- ft. Character of soil to a Idept0of 3 fee Sane- Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes 0 No ® New Construction: Yes 0 No ❑ FHA/VA; Yes ❑ No ❑&f/®fc°/I7a? TYPE OF INSTALLATION AND SPECIFICATIONS:' .D b4?""4 (No septic tank or''cesspool permitted if public sewer is available within 200 feet.) a . r Se •c Ta-n�- r� Distance from nearest well-----------------Distance from foundation'__----------------Material------.------------------------------------------ 4S�6 f 1�tt 7 No. of compartments--------------------------size---------------------`----------Liquid depth----------------- --------Capacity----------------------- Di�j>osal- Feld. Distance from nearest welL.%�_Q---_.Distance from faundation__ _ Distance to nearest lot line__�V____. is 11'y Number of lines____________ _____________ Length of each line______ -------------Width of trench Type or filter material- Depth of filter material__'-_ _s _.____Total length_:_. ______________________ 41 Seepage Pit: Distance to nearest well----------------------Distance from foundation------------.._..--,Distance to nearest lot line--_____________ . ❑ Number of pits------------------- Lining material "_-------:-----.Size: Diameter--------------------- Depth------.------------------_-- Cesspool: Distance from'near6st'well__________ _____Distance from foundation-----.------------- Lining material______------__.__-.__---______-_--__. ❑ Size: Diameter---- "fi r * Depth- ---------------------------- L---------:--------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_----! _ �Y, -----:-/----------------------Distance from nearest building------------------------------------------ E] Distance to nearest lot line -' ---=` ---------------------------------- ------------------ --•------------------------------------------------ r* `�, Remodelgand/ofrepairing {describe):" ----- ---- ------------------- v -- ------------=-------- -------------=--•-• ---••-----=------------------•------- --=--- -------------_==`"--------------------------------------•----------------------- a --- #1 I I-hereby certify that I have prepared this application and jTauin `t'fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulationsof the San J Local Heal h District. DAY 8c N1_'GI- T /9-1A ((Signed) ----------------- �- Contractor) EP'Ti�`T: TVK SERVIC_Eq , � 5- .- llra A S to�ict � -------------- Tit } r _ - (Plot plan, showing ]�H, c �r�o�sy34emlti?relation to �rells, buildings, etc. an a placed on reverse side). FOR DEPARTMENT USE-ONL APPLICATION ACCEPTED BY------------ ----- - - - . ��'-------------------------------------• DATE-- '2-`-`c - -- ----------------------------- REVIEWEDBY--------------------------------------------- --------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED =----------- I ---------------- DATE--------------------------------------- ---- i Alterations and/or recommendations-------------------------------------------------------------------------------------------•-•-------------•-------------------------------------------------- 1 4' ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ t . -----------------------------------------------------------------------=--------------------------------------------------------------------------------- I f . FINAL INSPECTION BY:....._ fP-E------------------_-------------------- Date__.. f� � - ----------------------------------------- SAN JOAQUIN LOCAL.,HEALTH DISTRICT F F 130 South American Street 300 West Oak Street �Pl 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4---2M . Revised 1.57 F.P.CD. � t