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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein-described. This a . . . -[3---o 30 --2-3 application is made in compliance with County Ordi nce,No. 549. i t Sk L/ fes ----- ----- --------------- ------------------------------------- JOB ADDRESS ANrA�10N_eV---------- --- -- ----- ---- --------- ---7 Owner's Name---------D ........ . ----------- ------------------------------------------------- ------------------------ Phone.----- - Address :. -----------------------------------__------------------------------------------------------------------------ Ja ------- ------------------------------------------------------------ Phone---------• ------------------------ Contractor's Name_...._ Installation will serve: Residence � Apartment House 0 Commercial 0 Trailer Court E] Motel 0 Other Ej Number of living units:/------ Number of bedrooms _.Number of baths -1---- Lot size _� ....K ___ _.._.- Water Supply: Public system W Community system El Private E] Depth to Water Table -,". ft. Character of sail to a depth of 3 feet: Sand F] Gravel Ej Sandy Loam E] Clay Loam El Clay El Adobe� Hardpan ❑ Previous Application Made: Yes [] No & New Construction: Yes ;g, No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:. Distance from nearest well__/.V&=,�c..Distance from foundation----/Q-.---_--_Materia1,_(S�iP)jZ_-_1111t--------------- Na. of compartments-- - - -iP------------- Liquid ------- Capacity-----40,0__ Disposal Field: Distance from nearest well.�UT%Z_Distance from foundation-----A/1--i-------Distance to nearest lot lin el-- ------------- Number of lines------/......... ----------Length of each line------ ------Width of trench-. _V.�-i------------------- Type of filter material-__/-,5......?R_Depth of filter material---- Total length-----------3-0-------------------- Seepage Pit: Distance to nearest Distance from %undation.... to nearest lot line ------ 2- Number of pits.--------/-----------Lining material_ --- & Diameter-----9.31........Depth-----—?.0------------------ I) Cesspool: Distance from nearest well------------ --Distance from foundation..,_---.-.-.-.---.--- Lining material-------------------------------------- IJ Size: Diameter------------------ -------------------Depth.---------------------------- --- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well.. --- --- -----------------------------------.-Distance from nearesf building__-_______._-._---------__-__-.-_---_----. ElDistance to nearest lot line---------------------- ------------------------------------------------------------------------------I---------------------------------------- Remodeling and/or repairing (describe)- --- - ---------------- ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- y at I hereby ce3 I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, nd rules and regulations of the San Joaquin Local Health District. ----------------------------------- wper ... ...... . .... ------ (Signed)---------- ------- /I"(--�.._ -----------4---------:5,40 --------- to and/or Contractor] ------------ itle ........ -7--------------_------- --------------------_(T By:------ iina size of (Plot plan, sho mg size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ------------`------- 1------------ -- ---------------------------------------- DATE------ --- --------------------------------------- --------------------------- DATE--------------—-------------------------------------------- REVIEWED BY-------------------------------- ------------------ ---------- -- ------------ - - ------------------------------------- --------- DATE-------------- --- BUILDING PERMIT ISSUED--------------------------------- ----�:�v ----- --------------------------- AI#erations and/or recommendations:- ---- Nj-----------------------------------------------------------------------------------7 --- -I- �r---------------------------- ----------------------------------•----------•---•-- --- ---- --------------------------------------- ------------ ---- ---------------------------------- 17 -------------------------- ------------------------------------------------------------------------------------- ---------------------------------- ---------- ---------------------------- ---------------------------------------------------------- _k --------------------------------------- ---------------------------------------- ----------- - _.. ) -------------- ------- --------------------------------------------------------------------- ------------------------------- ------------------- --- ----------- -- ---------- ------------------ - ------ -------- Date-. ------------------------ -------------------------------- FINAL INSPECTION BY:---- - ---- - ------------------------- - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street :Stockton, California Lod;, California Manteca, California Tracy, California ES-9-2M 145446 ATWCCD 12-54