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APPLICATION FOR SANITATION PERMITPe it No.,1 _R-__A___Q_____. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const "cf and install the work herein described. This application is made in compliance with County Ordinance N-o-•. 549 sJOB ADDRESS AND LOCATION. {1` --------- .- ----f- -------- Owner's Name--------------- `f -'^ x - -------------- ------------ - ------ one------------------------------------ Address-------------------e: - - = P - .� 1 �- Contractor's Name__._: _ Z!__ on Installation will serve: Residencei Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin _ _ r ;9 units: f__ Number of bedrooms _9___N umber of baths -------- Lotfts¢e _ yy ----------------- Water Supply: Publics stem r Co -s stem I PPY� I Y LJ y y �❑"Prvi ate ❑ Depth to Water able ______ ft. Character of soil to a'depth of 3 feet: Sand El,--Gravel ❑ S ndy Loam ❑)Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Y Previous Application Made: Yes ❑ No ��New Constructiori: Yes A' iVo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: R , (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well _cf ul i`'Uistance from foundation_- Q--I__ Material_e__ 14q [A No. of compartments___ -�_____________Size__ - rr'� �,-/� � �, '' ,f/ - --- -�---L:quid depth----:TY�.�---- Capacity-----�F-----��---�`-r---- Dis osal Field: Distance from nearest we�l�1' _�s_fr`�7 Disposal t Qistance from foundation___�.a�________Distance to nearest lot)ine____,_-1_._-_____. ® Number of lines_____ ?n,.k- .c---_-/--Length of each line____------1----_Width of trench_______________ �, Type of filter material_ _f en epth of fitter materiaL�_, �l--Total length--- ------------------� Q Seepage Pit: Distance to nearest well '`---- from Jo .dation___T..__________Distance to nearest lot line______ ------- 1 ® Number of pits------ L�___Lining materia!__- c £__ _ _*Size: �iameter_____:-T�__________-,Depth___. -�------------------ Cesspool: Distance from nearest well_______________ Distance fiom foundation-------------- ___.Lining material________-_____________-_- __ ❑ ^Size Diameter---=-------=------------_-�----- Depth--------------,-----:;----------------------------Liquid Capacity------------------ ..:_ gals. Y... �. �, _ t .� ,q �. _.. _ .� _ _ _ Priv Distance from nearest well - r ' `�"'"" �" ------ --- -------------------Pisfance from i earest building------------------------------------------ E-1 Distance to nearest lot line ---- -_____: ____ ___ + _ ---------------------------- -- .' .- ' i Remodeling and/or repairing (describe}________________ __ ---___--- .7 ----------------•----------------------- ri i � .o I hereby certify that'l have,p pared this application and that the work,Ewill be done in accordance with San Joaquin County ordinances, State lawsi and rules and regulations of the S n Joaquin Local ealth District. }y 4 Si ned ( 9 B s i - t h ✓ . # [Ow rand/or ontractor) r -------- Y --- ------- ----------- ------ /` (Plot Ian, showing size of lot, location of`sys#em in relation to wells,_____________ (T�tleI-_.__C"-:C31_�tr___- r P g Is, buildings.etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------- _1 ------ -------------, --- -_, s �, - DATE '-- AT REVIEWED BY --r- ------ ---------------------------------------------------------------------------------------------------------------- DATE--------/I-�C'.�lllLDI NG PERMIT ISSUED -------------------- DATE------------------------------ - --------------------------------------------- Alterations and/or recommendations:--------------------- -______._________._____ a _. w. --------------------------------------------------------------- - •------------------- ------------------- FINAL INSPECTION BY:-------tDate------------- - ----1_i _ � 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 . 6 ES-9-2M 8.51 Revised W-2100