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cel APPLICATION FOR SANITATION PERMIT Permit No.0 ____-_...._..�-- Y [Complete in Duplicate) Date Issued .Y I " s S>' Application is hereby made to the San Joaquin Local Health District for a permit to construct and'in'stall the work herein described. This application is made.in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_________ { 2. _ Owners Name = _74-- �._w .,/----- --------------------------------------------- r - ,. -------- x:= -r-�.4 ---- •--•---- -- ---•------ - 6 �� Contraetar's Name-------------•-------•- � - - -------------------.--•-•---- -....-------•-----...-- - ------- ------- Contractor's - -' ----� - ---- ------------ Installation will serve: :Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑Other ❑ Number of living units: ---A". N rnber of bedrooms . Number of baths _ .._ Lot size ----- / a -Ne---- ------- Wafer Supply: Public system Community system ❑ ' Private E] Depth to Water Table 4-1 f. Character of soil to a depth of 3 feet: Sand ❑ ravel ❑. Sandy Loam❑ ClayLoam Clay ❑ y ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No. New Construction: Yes [].,..No ❑ FHA/VA: Yes ❑ No �"�'�r T =�F INSTALLATION AND SPECIFICATIONS: !� (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) €y ep T-a Distance from nearest well.................Distance from foundation".._____.._..*____.Material_.__...____...-._ .._..._-_ I. No. of compartments Size--- --- ------ ---- -----Liquid depth---------- --------------Capacity----- ----•---- ---- sposal-F"eld: Distance from earest weil_. thtJ4 epistance from foundation__- �I 1 .............Distance to nearest lot line_.__-•--- Number of lines....__...__ __ Length of each line_-�_-/-----_-_-- Width of trench.._. Type of filter material._ _ ,_ _ // ----- ----- 111YYY Yp I -_ ' .._ .-_-_Qepth of filter material...__,l�___-"""_Total len th._. g0•--•------------------•-- 5eepa ePit: Distance to'nearest well_"-_- ----Distan -e"fromfountion__/ /-----.Distance to nearest.lot-€ine.Number of pits!___ ...__...__-Liningmaterial_ - : Diameter____. citDept . __s__ ____ Q-+ Cesspool: Distance from nearest well.........:......Distance from foundation---------------------Lining material.--_..__...___----._....__.._-____. /�"1 ❑ Size: Diameter--l-----------------------------------Depth--------------- - Li uid Ca acit 9 (� I - ------- ------- ---- -- - -- - Priv Y= Distance from nearest well------i..........---------_-------------- ----- __Distance from nearest building El Distance to nearest lot line:."___`..__ _ n __... r ---- ----- g p 9 t --------- Remodeling and/or re airin desciibe :..._._ �_ / ? "/ � "" ---------------------- •-----;-----------=---------------- --- --------- ------------------------ -----------•----------------------------- •- f4 I hereby certify that I have prepared fhis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local•Health District. DAY&NIGHT (Signed)------------- r.�tic_ a"r!k_Service------ } - �a �--,--t------- rrer sand/or Cantractar N.I.I n o P HO 2-7046 � /��i`( } O.w By:------------ - f ------------•--Stacktoas,£crl f:--------------------------- -------------------- - f� Tifife-- ------------ - 9 , placed of plan, showing size of lot, location of system in relation to wet �bildin s etc., an be laced on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED 13Y -------------------------------------------------- REVIEWEDDATE---- -------------------------------: I S BY ----- DATE ---------------------------------------------------------- BUILDING PERMIT ISSUED. i...:. --- - --------------------------------------- --------- DATE------ ---------------------------------------- 7 ------•------ Alterations and/or recommendations .____..__.___....___ --------------------------"•------•--------------------.---- ------------------------------------------------ ----•----------•---------------- ------ ----------------------------- - FINAL INSPECTION BY:______.. . _�' Date----- = f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-211 Revised 1.57 F.P,CO.