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r . APPLICATION FOR SANITATION PERMIT Permit No4_..!_.l.7. e. (Complete in Duplicate) �;y - Date Issue .___ _�___ ___..� Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrriib;d. This application is made in compliance with County Ordinance No. 549. f JOB ADDRESS AND LOCATION----A(-e- �--- ------- --------------------------------- •--••------------ Owner's Name--------------- dez� -- ------------------- ------ Phone -- _V -7{-Affil Address-------•--------_-------- [! „'° }'' ---------------------------------------------------------------- ---------- Contractor's Name---------- -------- ---- ---------- Phone/VW_.�':7f .z Installation will.serve: Residence ❑_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ .� Number of living units: __0 Number of bedrooms _ __ Number of baths __ Lot size ___72r' __.7 r___ __> ______________________ Water Supply: Public system r-Community system ❑i Private ❑ Depth to Water!Table !1.0_ ft. Character of soil to a depth of 3 feef:f: Sand ❑' Gravel[-] Sandy Loam El Clay,Loa ❑ Clay ❑ Adobe -]ardpan ❑ Previous Application Made: Yes 0 No New Construction: Yes A---N-o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if 1public sewer is available within 200 feet.)' i epti Tank: Distance from nearest well_________________Distance from foundation--------------------Material--------------_-__-__-__-_-_--_______..1________. No. of compartments r�_; - -�--- ---z t---------------------- ---Liquid clgpth---------------------------Capacity----------------------- Dis 'aa field: Distance from nearest well-------------- Distance from foundation_________.._;-----Distance to nearest lot line____________._... . -- ------=---------- Number of lines___________________________________Length of each line---------------------- .. Width of trench______._______.__ II Type of filter material----------------- --- -Depth of filter material-----------.--- -----.Total length------------- -------------------- ' r n �Seepag istancetn+aretZell�d_-�I�C_D Distance from to nearest lot l inee--- d-�-___DP Lg aldSizeDi �er___ Depth Q 1 r Cesspool: Distance 'f bm nearest well_______________=Disfarke from found ation_____.__-_.____.___.Lining material_-__-____________.___---_.__________. ❑ - p ;- .�,�A---�------Liquid Capacity----------------------------gals. Size: Diameter_ 'Depth = r ; I� `",� ' Distance from nearest building Privy: Distance from nearest'yell----- -----�--- - g 4 . Distance to nearest lot line-.----_----------------------------------- ....... ( • i01—f, Z , Remodeling and/or repairing (des'ribe]:--------- ---=- ---------=---- " - _ + - , ______________________________________________________________________________________________________________E____________-________________________________---_______.________________-___- -._______________________. a # l s` s ---------------=-------------------- ----------------- -------------------------------------------------- -- -- ------------------ --- -----------------_----- , I harsh certify-that that I have re orad thisa lication and that the work will�be done m accordance with San Joaquin Count Y y' P P , PP a , Q Y , ordinances, State laws, and rules and`r uI Cons ofFthe.San�oaquin Local Healfh District. (Signed-------------------------------------------------- - ------------ ------------`----------- ---- (O ner and/or Contracfor} % B ' (Title- . ----- --- --•-----tae P Y•----------------- �:�.�.. ..:., . e. �..... ,.....�.�.� (Piot plan, showing size of lot, location oo sys m rn relation to wells, buildings, etc., can be placed on reverse side. {37 6 � { FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- ------------------------ f DATE '-Sry------------------ L REVIEWEDBY------- -------------------------- --------------------------------------- DATE-------------------•---- - • - -- -- - •--- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE.------------------------------------------ - Alterations and/or recommendations:------------------------ -------------- ------------------------ ---------------. ------• •------------------------------------------------l-•--- ---- ----------------------------------------------------- ------------------------------------------------------ ----------------•---------------------------------------- ------------------------------------------------------- . E ________________________________________________________.. ______.____ __.._._ ........ _ .-------------------------------- .. ____________...____._______.__-__...______.____--_______ �� FINAL INSPECTION' BY----- ---------- j-.-------- _ ------------- Date------ ----/ `-` ! - r. -- _. - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California r FC-9-9AA R-;-4 4 W_91nn