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V APPLICATION FOR SANITATION PERMIT Permit No. -P (Complete in Duplicate) Date lssuedl�* /7 -15 -Ar/ . ........ Appliceiion is hereby made to the San ljoaquin Local Health District fora permit to construct and install the work hiprein described. in This application i's ma*,in compliance County Ordin c� No. 549. JOB ADDRESS AND LOCATION-----, --- ---- a. 1E, �a --------------------- - ---------------- 4, 5�:---ck I)Phori-e- Owner s Name-/ ... . .. ...................... 71 -------- - ----- --------------------------- Address .......... + Contractor's Name ...... ----------- -'--------- 'Phone Installation will serve: Residence M-,�Apartment 'House ❑ Commercial E] Trailer Court E] Motel E] Other El _4___ -:� Lot'size - — 'Y-- I Number of living units: -------- Nufriber of bedrooms Number of baths ----------------- __ -7 _ ------------ Water Supply: Public system El 7 Community system [:1 Private E] -Depfli-to'Water Table IP44. Character of soil to a depth of 3 feet: - Sand Ej.. Gravel F] Sandy Loam E] . Clay Loam 0 Clay El Adobe 2---H—ardpon Ej Previous Applica+ion Made: Yes L] No Dew Co'.n'strucfion: Yes Er'No El TYPE OF INSTALLATION AND SPECIFICATIONS: . ! i (No septic tank or cesspool permitted if puWic. sewer is available within 200 feet.) --- Distance from fou-ndatio ........ Se k Distance from nearest welIJ4-f n --- / 0 ro ---------- --- Liquid dep�h__a-5---- p No. of comp'artmerifs-1 - - ------------ SizeA4t_11! 70 ee Disposal Field: Distance from neapsf Distance fromoij ---- f nda1ion__* __Distance to nearest lot line ------ --- 7 Ar'�,' Number of lines---( ------------ - ------ Length of each line ---- -- wp� - ----- - _' Width of trench--- ---- Depth of filter material_____--------- ota Type of Cter mat6r'ial ---T I length_ - 7 --guff — ------------------------._ - -,f, " Di,tanct -f PuncIfi aoni__/_j0.`P__ Distance to nearest lob line Seepage Pit: Distance f� nearest well -44 ---- Lp-� Number of pits ------- i- ---------- Lln;ng material 1�� . ..... Si., : Diameter ---- V -- ------ Dept Cesspool: Distance from nearest well ------------------- Distance from 'undaf;on ------------------- Lining material-_-_________._ ❑ aterial----------------E] Size: Diameter ------ ------------ ---- -Depth- ------------------ I -------------- -----------------------;---------Liquid Capacity --- :._ -------------------- gals. k Privy- Distance from nearest well --------- ------ - --------------------- ...... ..-Distance from nearest building--* 'Distance to nearestjot line -__.--_--w---------------- = ......... 4— __ . ? --------------------- - ------------------ I -------------- ------------------------------------------------------- Remodeling and/or repairing (describe): ------ ....................... : --------------------- -------------------------------------- -------------- P -------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- -- �! -------- ---------------------- ------ -------------------------------------- -1 ------------- -------- ------------------------ ----------------------------------------------------------------- ----------------• --------------------------------------- ----------------------------------------------------------------------- ----------------------------------------- ---------------------------------- 7 ---------------------------------- ? -------------------------------- I herb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St e laws, an4 rules d rbgu ations of the San Joa uin Local Health District, 404g*._-*VKI�w Contractor) (Signed) --------- - QiAILL, ------- --- ------------------ - I ------- --------- ------------------------ ------------- ,-By --------------------------------------- ------------------------- ---------- (Tif lef -------- Rs • z ' of lot, location 6f sys+e (Plot plan, showing size in relation to wells, P"ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------- -------------- ---------- ---------------------- DATE --- Z_ --------------------------------------------------- REVIEWED BY --------------- ---------- _ ------ -- - ------------ - ----- ------------------------------------------ DATE____�- BUILDING PERMIT ISSUED ------------- ---------------------------------- -------------------------------------------- DATE--------- Alterations ATE--------- Alterations and/or recommendations--------------------------- ----------------- ----------------- _ ------------------------------------------------------------------ --------------------------- ------------ -------------------- -------------- ------- --------------------------------------------------------- ------------------------------------------------------------------------------ ---------- ------------------------------------------ ---------------------------------------------------------------------------- ------------ ---------------------------------------------------- I ------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --•------->----------------------------:-------------------------- -------------- ----------------------------------------------------------------------- I ---------- -------- --------- -------------------------- FINAL ,INSPECTIO'N'- BY:----- ---------------- -------------------- --- --- 130 South American Street Stockton, California ES -9-2M Revised W-2100 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California r Manteca, California Tracy, California