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1�y - APPLICATION FOR SANITATION PERMIT. . Perini � - G (Complete in Duplicate) _. Date Issued -_y/f��--)- 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. 5-49. JOB ADDRESS AND LO ATION------- Ph-` = on - ... " Owner's Name �.Q -- ------------------- ----- -- ---- ; Address--- r -------------------- --- :• ; --------- .) �L Contractor's Name---=--�-�' !f ---�•-� �- `��-: � � ��j ------------------------ •------------ Phone._�7_--4-_(p__---�-----8 --- Installation will serve: Residence �Apartmerif House ❑—Commercial —Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -L__-_ Number of bedrooms v2_ Number of baths -/-- Loi size ___ Water Supply: Public system Community system ❑ Private ❑ Depth to'WateFTable __-_:--_ ff. t Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [D-'Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [P/FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPI:CIFlCATlONS: (No septic tank.or'cesspool permitted if public sewer is available within 244 feet.) 1�-7 w - tic T nk; Distance from nearest well' -:`Distance•from'foundation-----------------------Material----------------------------------------..--_-.., 03 No. of compartments-------------------------Size------•------------- `----------Liquid depth-------7--------------- Capacity ----- �al,Field: Distance from nearest well............._?Distance from foundation---- _.Distance to nearest lot line---- �C1 Number of lines. Lengthof.each line------------------------------Width of trench.------------------------------. Type of filter material-------------- -------Depth of filter material---.------- --- --'_Total length---------------------------------- e ---------- _--__-------- Seepage Pit: , Distance to nearest elf_�v"_'___ -------Dista 'e•-f om f ndation____!_0..__.-D'stan—Distance to nearest lot line__ .__-----_ ~ Size: Diameter----• `� Depth 's --------------- .. `� Number of pi Lining material-- - - Cesspaol: Distance from nearest well----,eDistance from foundation------------- -----Lining material----------_--____-------------------_ _ ----Liquid Capacity--------------------------_gals. r ❑ Size: Diameter--------------- ' _---------De th-- ----------------------- - p i r r i Privy: Distance from nearest well -----=---- ---`-------------------- --- ---Distance from nearest building ----------------------------- I ---- - El Distance to nearest lot line--=---`--='"----=--------- -------'--------------•" - s Remodeling and/or repairing (describe).---- l ---------------------------•--------=-----------•-•-----------------•------ --•----•----- ------- -----------------------------------•-------------•----- ---------------------------------------- ---------------------- ----= . ' - f - ----- --------------------=-------------------•-----------,----• -------•-----•------------------------------------------------ I her certify that I have prepared this application-and that the work will be-done in accordance with San Joaquin County ordinances, ate laws, an rules and reg lations of the San Joaquin Local Health District. Ss neo _ Owner and/or Contractor] • r _ (Title)---- -- By: - ca :,"I . r (Piot plan, showing size of lot, location rof system in.r ation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY- � DATE.------ 2---- ---------------------------------•-------- APPLICATION ACCEPTED BY- --------------�---, ---- --- DATE / --------------------------------------�REVIEWED BY == BUILDING PERMIT ISSUED---=------=-------=--------- --- ------------------------------------------------------------ DATE --------------------- ^ r Alterations and/or recommendations:--------- -------------------------------------------------------------------------- ------------- --- .... ---=--------- ------------------------•---- -•---- ------------------------- --- ,I -----------------, - -_`----�-5-.- © � ----------------------------------- -------------------•---------------------------- --- �- I - - FINAL INSPECTION BY:�t - --------=---=-- :- = `" Date--------_-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American-Street 300 West Oak Street Trac California - Stockton, California Lodi, California Manteca, California y, ES-4--2M Revises 1-57 T.P.CO-