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APPLICATION"'FOR SANITATION',PERMIT P rmit No. W--___- � 1 L (Complete in Duplicate) .__ � _J`�_ 3.• �, � ] ate issued I'- .---�__-. Application is hereby made to the San Joaquin Local Hea1t}i,Disteict,for a permit to construct and instep the work herein described. i� This application is,made incompliance with County OrdinaVcie"No_. 549. ` - '� i JOB ADDRESS At 9_1OCA710N = "".--_--- -------- Owner's `Name }' C ------- , -- ----- --------- ----------_-- I ,-�- -- ---�'•' -� a•-�------------•----•- - - - --- `--`-�-=4•----�-------------�-- ---- - -- Phone- ---�--------- ---- --. - ---- - I� Address '4 --------_-• ----- - � Contractor's Name--------------------- - '== {,,,_, Phone__— _. ?�_ t II Installation will serve: Residence ,( Apartm on Hou e ❑ Commercial ❑' Trailer Court❑,.Motel ❑ Other ❑ iNumber of living units!/_-__ Number of bedroo s cr�_ Number of baths .Q- Lot size .--_--__ _-�_ �� Water Supply: Public system Community system❑ Private ❑ Depth to Water Table "ft. Character of soil to a depth df 3 feet: Sand Gra el ❑ Sandy Loam ❑ Clay Leam .❑ Clay ❑ Adobe Hardpan � � p ❑ ! Previous Application Made: Yes n ANo V New Construction: Yes* El I. TYPE OF INSTALLATION AD SPECIFICATIttONS: ! ii � � j (No septic tank or ces?pool permitted if public Jower is available within 200 feet) I Septic Tank: Distance ffrom nearesfi well--�/F Distance from foundation__/ __ - ---Mate_rial-----�r�-�'� �-'_______________ f No. of compartments________ ____________ _Size__f-� -f. �__Liquid d'eth_ �. _ _f____-CapacitY___. Q ___. t R Disposal Field: Distance from nearest ' I_-_.---------I-Distance from,foundation_______ __.____.Distant• to nearest lot line_________________ ❑ Number of lines--------------I--------------- LengWh .of each`•line------------------------------W'i`d$Af trench---_---•---------------------- W Type of filter material________ ____________1_Depth of,filter material-_-- --_ --.__.I___Total I tl ," .. .. �. 1.---__--__ Seepage Pit: Distance to nearest well, tr ------__Distance from founEtatian_ ,91------_--------.Distance to nearest lot line-_..;f_�______.._ Number *f pits---- ------------ Lining materia .L Size: Diam t -----.--------bepth_-F__--./�---------------- l Cesspool 4 ..,.Distance from nearest well.----Distance from foundation_________ --'_____ Lining mate lial-----�___________________ r ❑ Sze: Diameter ---.--'�---,� Dernth � -Ligwd Capacity ------------- � gals. Privy: Distance from nearest well_ ____________I_________________________________Distance fro n'ea est building:___-.__--_--'___________:__!-_-__-_._. ❑ Distance to nearest lot line - --------------------------------------------------------------- -- r r Remodeling and/or re airing [destr' e):__- ----- ----- --••-- ---- -------------------------•------ - $+ ! -- - - - -- Ir -----------------------------------------------------•------------•------------------------------------------- --------------- ----------------------------------------------------- - I --------- -- )I-------------;,b -1 = ------------------------------ I hereby certify that I have prepared this application and }hat the work will be doe iri accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he-San--Jua uih-Lociil,Healt{h-Dist;ic" 0t ,+ i (Signed)--------- - � "�'" - ---•--------- ----- wrier and or Contractor) B - Y r� --------------------------------------------------- Myl ------ -------------- y By: - E , } I (Tite��--- � r". .i (Plot pian, showing size of lo�ocation of stem in relation to wells, buildings, etc., can be pia ed on.rey♦. rse s�d� a FOR DEPARTMENT USE ONLY .11 JA I ,r '°`�E--------------- ------------------------ REVIEWED BY ------------------------------------------ DATE-'- BUILDING ,, .., APPLICATION ACCEPTED BY________ ______ __________ -------------------------- ATE` BUILDING PERMIT ISSUED_..__.____ __ DATE ) Alterations and/or recommendations _,�___ ____..._______ __________ __ f r__ -11 ` - i �----- + ------- -----Z - - -• •------- - .__ `------- - ---- - -- - --- -- ---- , •------------------------------------ ----- ---------------------------------------- M - ------ II ------------------------- ------------•- ---- -- ---- - = I � t s I FINAL INSPECTION BY:_.:__ 4' .1 ------- Date------------- --------------------- BY':' T r' ti SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300;West.Oak Street 132 Sycamore Sfreef 814 North "C" Street i I k. Stockton, California Lodi, California Manteca, California Tracy, California k '� —9-2M 10-52 Revised W-2100