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_ r Permit No. ____ -�� � APPLICATION FOR SANITATION PERMIT -- �y �(Complete in Duplicate) / P P � Date Issued ---��--d�--6---�1 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 Ordinanc No. 544. JOB ADDRESS AND LOCATION-- � _d r G� u �-� ` -------------------- r -- f1 Owner's Name--------------------•-----------•�C--Jk------V� -��1�1.- -f-=--------------------------------------------------- Phone--�_J�-�--j-------- Address------------------------------------- ��—- ' /7� /'NF1-.�"-----------------•--•�� Contractor's Name---------- 1�-1 -SSR ------- Q 1 -`S;- -- ------- Installation - Installation will serve: esidence ❑ Apartment House ❑ ommercial ❑ Trailer Court );� Motel ❑ Other 5664,614–r Number of living units: _- --__ Number of bedrooms --_- Num er of baths _- Lot size -------------------.----------.---------------------------_- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k: Distance from nearest well-________________Distance from foundation-_-_-----_____----.Material-_-----_-____-_---_-__.------------------------- 7 No. of compartments--------------------------Size----•---------------------------Liquid depth--------------------------Capacity----------------------- pis sal Field: Distance from nearest well------------------distance from foundation--------------------Distance to nearest lot line--__-------..-.-- _ idth of trench Number of lines-----------------------------------Length of each line------------------------------W L� Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ See Pit: Distance to nearest well---,-f ja)i L_-Distanc�e f�rpo fou dation.-_1-i _.Distance to nearest lot lin Number of pits------j-_-------_--Lining mat eriad4 -CEV .Size: Diameter '� � Depth Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- ❑ Size: Diameter--------------------------------------Depth------------------------------------- --------------Liquid Capacity--------------------------gals. Priv =T 'Distance`from-nearest wefl-------------------------------------------------Distance fro ----- --- -------------------••--------- y.. ❑ Distance to nearest lot -----`--------------------------------------------------------•---------------------- ` Remodeling and/or repairing (describe):---- -------------------------------------------------••------------•------------------------------ - ( --- --- -------------------------------- ------------------------------ .....---------------------------- - ----------------------------------------- --------------- ---------------------------------------------------- I hereby certify tha repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules d regulations of the oaquin Local Health District. (Signed) -� ` ------- QIi-.S �1 � M- c ontractor) �f • (Title)- ag -.�.� ---------- (Plot plan, sho g size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- DATE---�----------------------------------------------- ----- ------------------- REVIEWEDBY------------------------ DATE-------- --�'------------------------------------------- ' DATE----------- f�------------------------------------- BUILDINGPERMIT ISSUED------------------- ------ ------------------------------------------ Alterations and/or recommendations:---------------------- ------ ---- --- -------------------- ------ ----------- ---- - , - E __ R _` -� - - - - _-_ ------ -- FINAL INSPECTION BY-------------------------------- Date- - ----------- ►-; SAN JOAQUIN LOCAL HEALTH DISTRICT ' .. E, 132 Sycamore Street $14 North "C" Street 130 South American Shoo+ 300 West Oak Street Y tJ� Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M 9-51 Revised W-2100