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i0 . APPLICATION FOR SANITATIOV,.ZERMIT Permit No. _A44_'f .... F (Complete in Duplicate) Date Issued -_i1-.l-1 - _ 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'wi`ttk County Ordi No. 549. 4 or � ---- - - `JOB ADDRESS AND LOC ION------' -- ---- - - ----- ---- ---------- Owner's Name_------------- -- -- -•-•------ ------- -------• --- ---------------------------------- ---------------------- Phone------------------------------•-- Address-----------_ f ----------- ---------- •-----i,i / ¢ ----j---j Contractor's Name l`�- -• --------- one f" _G`"�_ Ph Installation will serve: Residenartment House ❑] Com nercial E] Trailer Court E] Motel E] Other Number of living units:/------ Number of bedrooms _7-_ Number of baths _f____ Lot size ...... x[ ------___'.______•__ Water Supply: Public system mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Qj_-blardpan ❑ Previous Application Made: Yes o ❑ New Construction: Yes Cj—,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No se tic tank or cesspool permitted if public sewer is available within 200 feet.) k tic Distance from nearest well --------------Distance from foundation-------------------Material----------------------.-------------------------- No.iof --_-___--_--.:-.._------.No.'of compartments------------- -----------Size---------------------------------Liquid depth--------.-------- ----- Capacity----------------------- Disposal d: Mstance from nearest well--------------- Distance from foundation:---------------....Distance to nearest lot line----___-----_-__- Number of lines------------------------------------Lengt} of,each line----------------------------_Width of trench-------------_--------------------- Type of filter material--------- ----------".._De ♦ fff 4t apt r•ia�i-----:----:-----------Total length----------------._...._ Dep Seepage Pit: " Distance to nearest well ___Distance om ou dation. Distance to nearest /_.. -------- Number Linin materia_. - Size: Diameter._ ---- Cesspool- ------ Dumber of its - - --- --=�--- --- ---Depth-_---- ---- / Distance from nearest well-----------------Distance ror found tion._..__--------------Lining.material----------------- . .__6 J— ❑ Size: Diameter------r------------------------------Depth------------------------------------------- -----Liquid Capacity----------------------------gals . Privy: Distance from nearest well____...........................................Distance from nearest building.__--...-__-__.-___-___--____-.------- . q, ❑ Distance to nearest lot line--------- ------------------ --------------------------------------•------------------------------------------------------------------- 6� A i .RemodAng ancQ;& repairing (describe)---- ----- ----------------------- ------------------••••-----------------•-•-•-----•---------------------------------------------------------- ---------- ------------------------------------------ --------•--------------- - ------------------------------- ----------------•----------------•....7--------;-------•------ -------•--------•----------------------------------- - --------—-- ------ - - -.--------•------•-------- -•-•-•------------ --•-----------•--------------------------------------------------------------------------------------•---------------------------------- I herebycertifythat l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, 'a rule d regulations of the San Joaquin Local Health District. (Signed)--------------------------------------- ---- - - ------------ -------------- - ----- ------ -------------- -- ------- . --- ner and/or Contractor) BY• -----(Title)------- . (Plot plan, showi size ,of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U_SE ONLY APPLICATION ACCEPTED BY------- �` DATE-•-- r � REVIEWEDBY--------------'--------------------------- - -.,_.. -------------------------------- - 1� - DATE------ -- • ---------------------------------------- -----------------------------------PERMIT ISSUED f----------------------------------- - --- --- TE-- ---- ----•-------------------------------------- Alterations and/or reca'mmendations_______ ....... � 3 ------------•---..--•-----••----------------------------------------------- --------- ` ------- -- ---------------------------------------•--------------------------------- --- -- -- - - '/- - -- - ------- --- -------•-------------------•- --- ----- }------ -----------•----- --- -------- -- ---- --------------- •--------------------- ------------- -------------------------------------- Ir FINAL INSPECTION` 'r€ `�-f�' Date. �- 0/ WY/SA � N LOCAL HEALTH DIS41CT y 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North '•C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 195446 AT....