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APPLICATION FOR SANITATION PERMIT Permit No. ... .!Z S1 _..- n (Complete in Duplicate) / Date Issued --�/-z��,�._ 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 with Count Ordinance No.•549. JOB ADDRESS AND LOCATION__�.L67t -9--- -- e-40-0—ad-4-i at--- (TtK. o--- -------------------------'--`•---------------- Owner's Name----- W-hl-1-i-77-en. --------•--------------------- --------- - ------ Phone-;,'54,0---T_ Address-------------------Q4....I......--Za3 f, 17q , 'q.an–tCG. Contractor's Name , drvl,S --------X-,� : ----------------------- sem, . Phone g jfv C,� --------------- - ------------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _--� Number of bedrooms _-I Number of baths --/--- Lot size ----/,��C__!_-r�1----------------- Wafer Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table vlr-Vft. Character of soil to a depth of 3 feet: Sand [Z Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [jPrevious Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ ��Ij �/ �w��gtj�4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) fit Distance from nearest well------------------Distance from foundation----.--_-_--__-.-.Material----------- .._--------- __--------____----_----. No. of compartments-. - ------------Size------••-----------------------Liquid depth -------------Capacity------ ---------------- isposal Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line----- ----.----------------...Width of french----------------------------------- Type of filter material------------------------ Depth of filter material-------- Total length_-.-----------------_-..--_-_-------__--_- Seepage t: Distance to nearest weil.A.0V Distant fr fo ndation-- -..-..Distance to nearest lot line---f---- -- [ Number of pits_---------------_-__Lining materia - --�.___'_�-.Size: Diameter__.Z.�_��_._.Deptn_��Q------___________ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------_-_---------. ❑ Size: Diameter-------- -------- --- ---------------Depth----------------------------- --- - -------- ------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------__-----__--__-_--_-----.-------_ �Ll ❑ Distance to nearest lot line------------------------------------------- - ----------------------------------------------------•-------------------------- ------------ Remodeling and/or repairing {describe)---------- -------- -----------------------------•----...-------------------•---••------------------•--- --------- ---------------------------- --------•-------------------•---------•---•---•-------------•----•---•--------------------------------- --•- ----------------------•-------------------------------------- 1 hereby certify that I ave prepared this applicati nd that the work will be a in accordance with San Joaquin County ordinances, St laws, ruI s and re Sa Joaquin Lo istricf. (Signed)-------- ---- ----—ij�_i -- --------r– " l C� - ----- ---------- - - ----------------------- ------ ------------- r Contractor) BY:---------------------------------------------------------- ------ -- - - - --- (Title)- (Plot plan, showing size of lot, location of stem in relati n t wells, buildings, etc., can be aced on reverse side). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -- ---- ----- -- -------------- ------------------------------------------- DATE----- 3C�------------------------------------------- REVIEWED BY ---------- ------------------------- -- - - ----- DATE---•- �c BUILDING PERMIT ISSUED------------------------------- ----- ---- DATE--------------- ----- Alterations and/or recommendations:_-_-____-...-- �- -----------------•--------•--------•------------------------------------ ---------- --------------- -----...-------------------------------------------- -•-------•--------------------•------------------ ------------------------------------ ----------.--------- ---------- -----------------------------------------•--------------------------- --------------------------------------------------------------•-------- - ------------------------------- ----- --- - - ---- ------------•--------- FINAL INSPECTION BY:.- Date .--------�------------�-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfraef Stockton, California Lodi, California Manteca, California Tracy, California EE-9-2M 145446 ATw000 12-54