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a,2-3\5q 'Y APPLICATION FOR SANITATION PERMIT Permit No. ._�.\.. n____ (Complete in Duplicate) 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 CATION------ ir Owner's Name_,----- -- W-1------------ -f_l�l� � Phon 1� Z Address......... - c -.Ci� _ f l-_ � G - �/ ------------/ Contractor's Name_ _ _._��/Q_ _1e�/.5 -- _ r�J------ ------------------------------- Phone_ _ z__ UQ-�7 Installation will serve: ResidencKNumber Apartment House [] Commercial ❑ Trailer Court ❑ Motel ,❑_Other ❑ Number of living units: ___ of bedrooms _plumber of baths .� ----- ------- Lot size�--��,1,�-------� /A ��.� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIpiCATIONS: (No septic tank or'cesspool permitted if public sewer is available within.200 feet.) is^Ta : 1/rN y Distance from nearest well-----------------Distance from foundation-------------------_Maferial------------------------------------- _._.____ _ _- No. of compartments-_ ______Size_________ __Liquid de th____ _-____.____Capacity _Qs r_f is os Field: Distance from nearest well.-� nn___._._.Distance from foundation___----� ____.Distance to nearest lot line_- ___. __ Number .__ of lines___-_____�_.,__ __- Length of each+ line_________ __ --__".__.Width of trench_.:_ 9 Q• J� --- Type of filter materia#.__'__ _ _ __ Depth of filter}material____ e-._- Total length---------`—------------------ -- See Pit: Distance to nearest well---/Q0_........Distance m .founclaticn_,-t-____ r __.___.Distan`itq nearest lot linen______ ; Number of pits------- -1----------- material *__-_ .(_.Size: y___�...... ___ € Cesspool: Distance from nearest well________________Distance from foundation------ "" ""'`Lining material_______--_-__-_.____._______________. U ❑ Size: Diameter--------------------------------------Depth--- -------------- ----- --------------------Liquid Capacity... gals. Privy: Distance from nearest well------------------------------------------------- from nearest building-;__._.______________________ T ❑ Distance to nearest lot line- ------------------------------------------------- ---------------- ----------- -------- ----- - - --- --- -- - 4 � Q Remodeiin and or repairing describe / p g t ----------- ....... ---- --x- -- _-___------------------------------__k ____ _____________--___ _____--r� w_: - _ - -'----- -- ---------- "-------- ------------------------------------------------------------------------- - i hereby certify that I have prepared thisa piication and that the work will'be done in accordance with San Joaquin County ordinances, State laws, and a Fregu io of the Zanoaquin Local dHealt/ hDistr' (Signed) a Owner and/or Contras r U "ti By --------------------------------------------- ------- t - -- - I (Plot plan, showing size of lot, location of system in.relation to wells, bu' gs, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY----- -R-` -`------_----Z---------------- ----- ------ DATE------- _-_ REVIEWEDBY------------------------------------------ --------------------/------------------------------------------------------- DATE -- ---------------------------- BUILDING PERMIT ISSUED-.-.__.---------------------------------- 'f--------------------------------------------------------- DATE Alterations and/or recarrtmendations: �AC V-- 0 0.nl=t-F. 1 ------ -------RFP��1 AI 1-- �i� '[`3_ _ I.Q�1 ----------------------- t �Id'r'�-------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ------ ------ ------- t --- - -- ---- ------ f A P -i ----- -------a-- ------------------------------------------------------------------------------------ ------------------------------- -------------------------- FINAL INSPECT'JON BY:----- Q__ 2 Date---------g---- '2- 3 f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revises 1.57 F.P.CO.