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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 application is made in compliance with County Ordinance No. 549. : . K-- JOB ADDRESS A LOCATION-F`",,'Y�------------ v "! ---- ---------------- ------------ - - ---------------------- U ------------------ Owner's Name---------Y--- - i ---- --------------------------------= --------�---=---------------------- Phone - t pp Address.. iG, ---- - ------------ ------------- ------- ----------- ------ �--� ; ----- �-/J-,- °' ' Contractor's Name._ r � �--- -- - s�l.lfi,-� TL ------------- one--�.------ --_��J- . - Ph Installation will serve: Residlen�ei d Apartment House ❑ Commer ial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unity ----f-- umber of bedrooms - -- Number of baths .--1--- Lot size --- p-- -- ------ ----------------------------- r Water Supply: 'Public system Community system [I Private ❑ Depth to Water Table -------- ft. Character of soil to a depth Of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;PNO Clay Loam E] Clay ❑ Adobe Hardpan L]Previous Application Made: iYes [] No e New Construction: Yes ❑ TYPE OFJWSTALLATION AND SPECIFICATIONS: 'µ(No septic tank or cesspool permitted ' ublic se er is available within 200 feet.] rn-- ,CM�alt/ef �+ Septic ank: Distancel�from nearest w•eIP''V_ CDista �Q � No. of compartments-- ---__--.. Size --��quid ept6---------- --- --•--- �. l ''..'' �� r / Dispos i Field:l Distance;Ifrom nearest well'W. C Distance from foundationl��/�w- . - istance to nearest lot line-_�� . !1 Number 'f lines---------4-_-__ Length of each line---- ,� Width of trench.------- -.--------- Type of filter mateia ...1�Y(�.Depth of filter material_-__- 1-- -------.Total length-_-_-_-.-._-�--- -- -----.7_..)- `- ~i Seepage Pit: Distance to nearest well-��`�-- - -Distance, rom foundation_-_rZ--•,5_--_.Dist nce to nearest lot } Number�of pits...._______________Lining materials.._5?/` ------- Size: Diamete��_ �......Depth-�-,�- - -----._ Cesspool: Distance from nearest well-----------------Distance from foundation....__.--_.--------.Lining material----.-----------..--_.------__-__-_. Size. Diameter---------------------------------- --Depth--------------------------- --- - -- -- -- -----Liquid Capacity als. \l Privy: Distance�:from nearest well--.---------------------------------------------Distance from nearest building-------------.-------------------------.-. ❑ .. Distance.to nearest lot line----------------- ------- ------------ ---- ------------------------------------------------------•------- - ----- '• ------------- Remodeling ---------Remodeling and/or repairin. (describe):--------------------- ----------------- -------------------------------------------------------------------------•-:------------------------------------- ------•-----•----------------------•.-.-.-..--------------••---••----•----------------•-••----•--••-•--------------------------------------------------------------------- t I ----••---------------------------- - I hereby certify that I,Have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,R d!rules and regulations of the San Jo quip Local Health istrict. - - ---- ontract ) (Signed)--_ - _ ...r- a c or f r B = (Title) 1 �T ---------- Y �t (Plot plan, showing size of lot, location of ystem in relation to w Is, buildings, etc., can be pjp&d on reverse side). :ISI FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED1 g ------------------------------------------ --- ------ --------------------------------------- DATE....`—._ ------•------- -------•----•----------•------•-- �I RI=VIEWED BY-----'-------------�---- ;--- ---- ---- ------ • -- --------------------------------------------------------------------. DATE-�-------------------------------------------------- ------------------------PERMIT ISSUED;-------------------------: v: - - ----- ------•-• DATE.---- ---- -- -------------------------------------- t Alterations and/or r commendations: -- ----- -- ---- -- -------- ---------•----,--•-•------- -- ----------- .--------- ,. -- ----- -- - - _- -- ------- - -------- S �o - ------------------------------ ----------------------------------------- ---------- ------- ----- . -------- ---- - = - - ---------------------------------------------- ---- ---------- ------ --- ---- - ------- --------- --- ---------------------------- FINAL INSPECTION BY:; •------------------- Date....J.-0_' . ._. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street' 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 115446 ATWOOO 12-54YY , II -