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'10Z------ --------------------------------------- ------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------- (Complete in Duplicate) "'T----.-- ------- --- r - ------------- --- This Permit Expires I Year From Date Issued Date Issued Application 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 County Ordinance No. 549. JOB ADDRESS AND LOgATI QNJ`"--/ kxek.115�- 7 -----------------1*1**------------------------11--*-------11-------------------------------- Owner's Name ---------------••---------------..__..------ ---------•----------•------- Phone.. Address-.-----------le�. - -------------------------------------------------------------------------------------------------------------------!--------------------- Contractor's Name----------G. ----------•------------------------------------------------------------------------------------: Phone.................................. Installation will serve: Residence M--l-partmen't House E] Commercial r F _] ,, Trailer Court [-] Motel Ej Other ❑ Number of living units: I— Nu M,'ber of bedrooms-3-_ Number of baths -,/--- Lot size w-f-eA. " -------------------------- Water Supply: Public system W---Commun'ity system E] ' Private 0 Depth to Water Tabl'./ve"4. Character of soil to a depth of 3 feet: 'Sand [] Gravel E]. Sandy Loam E] Clay Loam. C3 -Clay E] Adobe EP-Frarclpani-o Previous Application Made. (if yes,date--------- ------ ---) No Eq-' New Construction: Yes ❑ No �] HA/VA: Yes E-] NoEjr— fYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) Septic_Tank-, Distance from nearest well________.-_—Distance from foundation------------------Material-t-l'-----------------I ----------------- 0.9-j/for No. of compartments�---------------------Size--------------------------------Liquid clepth---------- ---------�'--Ca'pacity----------------------- Disposal Fieia: Distance from nearest well._..—---------Distance from foundation...A-2-----------Distance to ne"a`r�sit lot line---t6---------- A;, Number ber of,I ines!--------/------/-------------- Length of each line.......ZP-1--------------Width of trench,2--e-------------- R, P,1`14f St k Type of filter material Depth of filter material---X-e---------Total length_____, Q 1_______________________ 4. , 4- e Pit: ;'-,Distance to nearest well---------—-----------Distance from founJotion--- 9 -0----.---.Distance to nearest lot line--- El Number of pitsJ----i'/------------Lining material.-_ __Size: 3 -.Size: Dia meter.,-Z. Dept h--AP ----------------- Cesspool: Distance from nearest well.----------------Distance from foundation-.,---------------Lining material--____._.___-____._.____-:- - ----------- ❑ Siz6: Diameter-- Dept h-----------------------------------------------------Liquid. Capacity----------------------- gals. Privy:., Distance from nearest well-------------------- -------------------------�--Disfance from nearest building._-___.-.___________-❑ --------------- Dist.a'rice'"to nearest lot line-- ------------------------------ --------- -A Remodeling and/or repairing (describe):_;_______________ :----------------- I - A?!�, -------------------- ---------------•----•----------------------------------- -------------------- ---------------------------------------------------------------- ------------------------------:--------------------------------------------- ---------------- ---------- ------------------------------------j---------4-i-----------I--------------I-------------------- ------------------------ -------------------------------------------------------------------------------------------- -----------------------------------------------------Z--------------------------------r------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I h'a've"prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,, and rulps and regulations of the San Joaquin Local Health District. (Signed)------------------- ,-490......4---------------------- -- ------ --- ----------- ------- ntractor By:__...------------------------- '----------------------------------- ------------- -----------------------{Title).1 - --- ---- - ----------------- Olot plan, showing siie of lot.' location of-s`�;ie ed f 9 -L mt�n�elafion to welli,'biuildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.By---,,07- ------------------------- DATE------ -------------------------- REVIEWED BY---------T -*---------------------------- ------------------------------------------------- ---------------------------------- DATE------------------- 4 BUILDING PERMIT ISSUED ---:-A-k-_2------------------------ ------------------------------- -------------------- DATE------- Alt era fi ions an)/or reyomn)i,�Adatians----------------- ..... ... - - ------------------------------- ------------------------------ - ------f ------ --- - ------------------------------------------------------------------------------------------------- -------------------------------------Z---------------------------------------------------------------------------------------- ------------------------------ ---------------------- ------------------------------------------------------------------------------------------------ ----------------------------------------------------- ---------------------- ---------------- ---------------------------------- ------------------------------------ ---------------<-------------- ------------------------------------------------------------- -------------------------------- FINAL INSPECTION BY:.. Date._.---- �~.�� SAN ate,'—----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street'. .�1,24SYcamorosstreei i,� 205 West 9th street f Stockton,California Lodi,California Montetal Call4rnla-j Tracy,California