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1M ~ APPLICATION FOR SANITATION,PERMIT Permit No. -- (Complete in Duplicate) 7/ •S.-n..D0e[_(_. v� . Date Issued -----/-- / i'?S 2_Y-1P-f2_ 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 wit C- my Ordinance o, 549. JOB ADDRESS A LOCATION.64- 4L�- . - "" c � - -------------------------- Owner's Name- -- -- ' - $_ .--------- Phone. * - - ---------------- ------ r -- - •---------- -- ----------------•--------------•-•------------•--------------•------------------------------ ----- •------------ Contractor's Name___-_+� -p-h ---------------- ------------------- ------------------------------------------------------------••--- Phone..----------- --------------------- Installation will serve: Residence ©"O'Apartmenf House ❑ Commercial E] Trailer Court C]r Motel E] Other ❑ Number of living units: ___I____ Number of bedrooms _J___ Number of baths J---- Lot size --- _ Water Supply: Public system Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay C] Adobe Hardpan E]Previous Application Made: Yes ❑ No V; New Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic tank or cesspool permitted if pu6ljc serer is available within 200 feetp) + Septic 'ank: Distance from nearest well"SDa c fro found Sfil No. of compartments_.. tion_. __ v _..__,. ...._.._.__Size___--_ � r'' Liquid depth- = ----------Ca aci Disposal,Field �Disfance from nearest wei 0 '1 is'tance {ro foundatlonl _ stance to nearest lot li Number of lines--------�---.Y4, � �- ---------- ---- Number Width of french__ "_ Type of filter materiaiDep}h of filter materia!___.._ ---------Total length___-___ 2Q___--------------" Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-____._-_________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth- -------------------------- ,�ro Cesspool: Distance from nearest wel ----------------- from foundation.____..__..______-.Lining material--------------.__.__._________- ❑ Size: Diameter------ `------------------ -----------Depth----------------------------- -= Liquid Capacity -------------------gals. Privy: Distance from nearest well__________ ` _ Distance from nearest building -------------------- ❑ Distance to nearest lot line------- ----------------------•-------------- Remodeling and/or repairing (describe):--------------------------- -------------•-----------•------------ --------------- ----------------------------•-------- •-----------------------------•-------------------"------------------------------------•"---------------•--------------------------------•---•-------•------------------------- --- -- I 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 Joaquin Local Health District. (Signed) - - and/or Contractor] _m j ------------------•-- ---------- SY� /owing --------_. •---------------- --- .--- Title Piot plan, ssize of lot, location of system"in relation to wells buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - r - - --------------------- DATE-- REVIEWED ------ - EVIEWED BY----------------------------- -- -- - ---- -•--._---- DATE------- - --------------------------------- -- -- ------------------------------ BUILDING PERMIT ISSUED ----------- -----------------------•---------------------------------------- DATE. Alterations and-or recommendations:_.____ ---- - ---------- ---- " --------------- -------------------------------------- • ----- ----------------------- ----- - ---------------------- - ----------- ------- ---------------- ------------------------------- FINAL INSPECTION BY------------ - - ----•- ------- Date---------- -� -�- s 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 i E5-3-2M:' 145446 ATWnO"