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k-'A APPLICATION FOR SANITATION PERMIT Permit No.,Z-6—fl. (Complete in Duplicate) Date Issued fi __A- /S2 Application is hereby made f6 the San Joaquin Local Health District for a perrn"it to co struct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ----- -- -------- ---------------------- JOB ADDRESS AND LOCATION------------------ -- -----------V/A-------7------------ --- ----------------- Owner's Name----------------------------- ----------- ... ... ..... ------------------------------------------ Phone--------- -•-----------------------. Address------------------------ - A- —?- .--,pW — -- Contractor's_- Name------------- - Phone --- -- - - Installation will serve: Residence [j Apartment House E] -Commercial ❑ Trailer Court E] Motel [] Other E] Number of living units_ ___ ber of bedrooms -A- Number of,baths /---- Lot size,......*____r_____________-___-•___________________________ Water Supply: Public system' � tmunity system El Private E] Depth to Wafer Tabl ff. a" f 3 feet: Sand Adobe�k Hardpan Character of soil to a depth of ravel El Sandy Loam E] ay Loam E] Clay E] Gr ay I Previous Application Made: Yes E] No New Construction: Yes ;�No EE] TYPE OF INSTALLATION AND SPECI FICATIONS: (No septic tank or cesspool permitted if publi is available within 200 feet.) Septic Tan Distance from nearest A M ferial--- - ------------- -------- ell -Y..z' z "fance from foundation__ ize 3x--46 . z 'r- No. of'c0:2rn. parfmenfs-. -------------- F--------Liq - --- uid dr et-------------Capaci y- -- -- ---------- Dis Distance from nearest weh.A/064-Distance from foundation_ 1-4-��.Disfan`ce to nearest [of Ii --k4------- P1� 11 Number OT lines,l---- --- ---Length of each I�nej,�---UP-9---d Z-__.Width of trench._____9 1-- - - ----------- 1-4-1 ________Total length___,__2-d--------------------- ria Type of filter maferiaIZA- __:__o_- __ o-Depth of filter mate Seepagelpif: Distance to nearest well-----------------------Distance from foundation-----------------Distance to nearest lot line______._____..._ � ; ❑ ine----------------- 0 Number 64 pits--------"-------------Lining material----------.--------.--.Size: Dianrefer---------------- h------ ------ ------------------ Cesspool: Distance from nearest well-________________-------Distance from foundation-_.-________.___,__.Lining material____-_._____--------.______-__-___._ - ------------------- E1 e ----- Liquid CapacL it Diameter.____ -pth als Privy: Distance from nearest well___.________---------------------------------------Distance from nearest bufllin........... ---------- El Distance to nearest lot line----------------------- ...... -- ------------- ........ -- -------------- airing (describe):____-__-_._ " ------------- ........ ... Remodeling and/or repairing ------------------------------------------------------------------------------------ --- -------------x---------------- ----------------------------------------------------------------------------------- .... ---- ---------------------------------------- --------- ------- - ------------------------------------- ---------------------------------------- ----- - --- ------- ------------------------------------ --------- ------------ ---------------------------------------- --------------------------------------------------------------------------------------------------------1--------------------------------------------------- -------------- I hereby certify that I have prepared this application and ifiat the work will be done in accordance with San Joaquin County ulaffions off.. ordinances, State Wile S, and rules Vand ra),,+he San Joaquin Local He Ith District. ---- - ---- . . .....Ow - ---- ---- ---------- - .........(� (Ow r and/or ontractor) --- --- --- --- ffitle)---- -- ------ ----------- - - -------------- By:----------------- --- -- ------ -------------------------------------------------------------------------------------- XZ --- -------- - (Signed) (plot plan, showing size of lo+i, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ----------------------------------------------------------------------------------- DATE-4'—�- ---------------------------------------------------- REVIEWED BY------------------------- ------ ----- --------------------- ----------- DATE-----ZZ- -------------------------------------- ----------------- -------------------- - ------------- .. BUILDING PERMIT ISSUED--9--V------------------------------- -------------- ------------------------------ DATE------ ------------------ -------------- -------- --------- ---------- Alterationsand/or recommendations:-----------------------------------�-------------------••-------------------------------------------- ---------------- ----------------------------------- ;I I ---------------------;---------•------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------I-- ----------------------------------------------- ------------ -------------------------------------------------------- ------------------------------------------------------------- ----------------------------------------------------------- ------------------------------------------------- -------------------------------------------------- - ----------------- ------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -------------- FINAL INSPECTION BY.--"-------- 0 -•----------------------------- -------- D -------7-------------------------------------- ate--- - -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT : t 130 South American Street 300�West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Ltdi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100