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APPLICATION FOR SANITATION PERMIT Permit No. f 3 . 30 (Complete in Duplicate) ^3 Date Issued ______ 1 Ii afion 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. 670 JOB ADDRESS AND LOCATION-/--�46 t_• --- „, Owner's Name-----------------------------------L._� v-/✓�+ -- -------------------------------------------- Phone---------------------------•--- Address-------------------------------------------- �-�. dr. y..; t------------ --------- �w Contractor's Name---------------- ----- &-f- v -------------------- ------------------------------------------- Phoned d Installation will serve: Residence C8 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _1__ Number of bedrooms Number of baths ---/-_ Lot size _:-__-__.-__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TableSa ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJ4 Hardpan❑RC1 Previous Application Made: Yes ❑ No�' New Construction: Yes ❑ No ❑ ..: Qom) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public e wpble within feet.) frDistance from nearest we111J_-______ _�anceomfaundaoMaterial_____________________________________________ No. of compartments------ ------------- i -------------------Liquid depth-------------- ---------Capacity-------------- ------ - e� Disposal Field: Distance from nearest well -.______.D st 'from foundation_ _-2-_ __._-Distance to nearest lot line--- -____ }-. Number of lines-----------/-_-______ Length of each line_IV--------------------Width of trench...�_O---- Type of filter material____�Wy4(e74fof filter material__-��_____________7otal length____ C_'__.___._________________t-Distance to.nearest we!!_. T___�_ ance from_fou_ndation�_r .___.Distance to nearest lot line-----r.�___P. �. Humber of pits-_._____________Lining matenalC __ -.__.__ ptn- f Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-._-__.______--_____________-__-_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-_------------------------gals. Privy: Distance from nearest well__ -------------------------------------__Distance from nearest building__.__.-.____________.__________._.____--. ❑ Distance to nearest lot line------------------------------•---------------•---------------------- ------------------------------ ------------------ ----------_ /p �Q Remodeling and/or repairing (describe):-- _-_��f'_,�--s----��:-�------ ----------------------- - -------------- &.,& -- yx -------------------------------------------------•---------------------•-••-----------------------------------•------•----------------------------•------------------------- -----------------------------------------'-- I hereby ce i that I have pre ed this application and that +he work will be done in accordance with San Joaquin County ordinances, State la , and rules an egulations of the San Joaquin Local Health District. {Signed�--.--•--------�--��----•F-- ---- -_-_l =__--------�---- ------Title------ -��' Contractor] G� ----- ---------------------------- --------------- --------------------------------------------------- 1 - (Plot pian, showing size of lot, location of system in relationt ells, buildings, e , an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY4 ----------------------------------- DATE-------- ---�----:------------- ------ REVIEWED BY------------------------------------- --------•---------------------------------------------------------------------- -------• DATE------------------------- .- --------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-•------------------------------------ ------------------ Alterations and/or recommendations------------------- ---------------------------------------------------*-------------------------------------------------- ----------------------------------------------------------------•-----•----------------------------- ------------------ •-------- ---------------------------------------------------------------------------•---------------- FINAL INSPECTION BY:------------------ '---------- Date =3 -- --------- 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 ES-9-2M 10-52 Rovised W-2100