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APPLICATION FOR SANITATION PERMIT Permit No. .,Xlr.. ...3-3-- (Complete in Duplicate) Date Issued -__�y_7 512-7 - . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatioh`_is made in compliance with County Ordina e No. 549. JOB ADDRESSAND C l0 �� -------- -------------=------------------------------------------------------------- Owner's Name--- ._ - - -------------------------------------------- --------------------------------- ------ Phone------------------------------------ Address -- --------------------------------------------------------------- Contractor's Name , _.. /G- - 4- - , one ---------------- Ph ------------------------------------ Installation will serve: Re ides e Aparhmerot'House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,_=_=Number of bedrooms _ Number of baths _/___ Lot size ------------__________________ Water Supply: Public system ❑ Community system ❑ Private'�epth=to Water-Table, _f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam•❑ Clay ❑ Adobe-' Hardpan ❑ Previous Application Made: Yes No 1 pp ❑ � New Construction: YesNo FHA/VA:-Yes 'No [J'� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) l " Septic T Distance from nearest well �" Distance f _foundation____ y No. of compartments _____ Size__ 1_.__ p -- --..r_ � _ _Liqurd depth----` - ------'---Capacity_.. _____-- Disposal Id: Distance from nearest well__��:-,_k"' D+stance�•from--oundat' n_ _ __�.__.Distar<ce�to nearest of line_____ Number of lines--------/------ " Length of each line__ _� Width of trench__ - �ss� ------------- Type of filter material_ _�.!«' Depth of filter ma#.eaLj -455 .__-____Totalleng#h fou atian___ �- ___ .___ =__:___., t �to nearest I Ii -_� See a e -------- Number of pl+arest well .��_g mDateraalc��Jfr - _ _ ,• p g -- �� _ 5ize;rDiameter__ Depth -_____t--'--- - - ., Cesspool: Distance from nearest well_______________ Distance from foundation..�_-------�.__-_.Lini g material,_ ------------------------ ❑ Size: Diameter-- - -Depth----------------------------- -------------\__Liquid Capacity-------------- gals:. Privy: Distance from nearest 7611_7_ - ____=------------- _____________Distance from-nearest building- � g---------------------------1_� 1'-N ❑ Distance to nearest lot line--------- -f----- * = = - ' Remode€Ing and/or repairing (describe):-------- -----•---------------•--------------------•------------------- ' -----•-------------------------------`--------------------------------------------------------------------------------------------------------------------------------- 4 ------------------------------------------------------------------------------------------- 1' hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Count ordinances, State laws, and rules and regulationsf a San Joaquin Local Health District. , (Si ned 9 )-------------•--------------------- — - --------- ----------------------------------------------------- -----(Chvner�rtd�v Contracfor) B Ti � - Y� ------------------------- --------- ----- ------------- ----- (Title) (Piot plan, showing size of lot, location `stem in relation-to wells', buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ "- - ------------------- - -- ---------------------------------------- REVIEWED --------------------------------------REVIEWED BY----------------------------------------=----------------------------------------- ----------------------------------------- DATE ! BUILDING.PERMIT ISSUED-------------------------------------------------------------- ' y DATE ( ' ---------------------------- Alterations and/or recommendations--------------_-----.._____________ _.______ T- -----------------------____ ------•--- ------------------------ ----------------•----------------------------------------------- •------------- ------------------------- ------------------------ .--- ---------------- ----- � ----- ----- -------------------------------------------------- --- ---- - ---------------- ------- --------- --- •-------------------------------- ------------------------- - ---- -- ------'-------•----------- -- ------- - - -��.-:j c ut,��----�--_—1- �t�a��- FINAL INSPC-SON - Date------_ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West QakStreet�i ' 132 Sycamore eStr4f, 814 North "C" Street Stockton, California Lodi, California E Man+eca, California( Tracy, California E5-9-2M Revised 1-57 F.P.CO.