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�tp� �L APPLICATION FOR SANITATION PERMIT Permit No. ----0-_J---..-T.... I� (Complete in Duplicate) Date Issued Applica+ion 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 clmpliance with County Ordinan No. 549. i JOB ADDRESS AND L 71 N-------f /!- . ........ --- - . Owner's Name y r Phone- -. ,S`dO ------------------- ---------------_--- Address `�� s---------------------- „. ---- -•---- Contractor's Name---------------- ----------- ------ ------- ------- --- - ---- -A----- • Phone��a ---------------------------------- -- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number f living units. _/___ Number of bedrooms ------ of baths -/... Lot size ----_-.5--6-.IX ---------------------- Water Supply: Public system 25"-Community system El Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B—'gardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes E] No [ 5 �. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 280 feet.) Tank: Distance i�from nearest well--;--------------Distance from foundation--------------_-.-.Material----------------------:._---------.-----_----.-. No. of compartments--------------------------Size-----•---- ••------ ----- - Liquid depth------------------------.-Capacity---------------------- il Dis Field: Distance `from nearest weli.................Distance from foundation-------------- ..--.Distance to nearest lot line------------------ Number of lines-----------------------------------Length of each line---------- ----......Width of trench----------------------------------- P .g illilter material---------------- epth of filter material-----------------------Total length--------.--------------------------------- T e or f c�� 1 s—. See a e Distance nearest well-914- -__Distance m fpu ation___.- Q__-___.Dlstance to nearest Iot.lioe----------------- Number Size: Diameter___3_3 lumber of pits------/------------Lining material--- ---------------- - .�.i � -----.Depth.->�74----- ------- ---•-- Cesspool: Distancel�from nearest well-----------------Distance from foundation___--------_________Lining material------------------ --_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. N\1 . Privy: DistancJIfrom nearest well --.._------------------------------------------Distance from nearest building----.-----------------------_------------ ❑ Distance:�fo nearest lot lire-------- -------- ------------------------ - ••-------------•_-- ---------------------------------------------------------------------- Remodeling and/or repairing (describe)----------- ----------------------------------•--•--------------------•-------------------------- --------------....-.------------------------------------ -------------------------------------------------p--•----------------------------------------------•-•--- ------ ••------------------•-•--------•--- ------------•-------------------•---------------- --------- . . I hereby certify that I have prepared this application and that the work will be done in accordance with'San Joaquin County ordinances, St a ws, and rules and regulations of the San Joaquin Local Health District. J (Signed)----------- ---------�p ---------- nor and Contractor) Plot Ian, showing-------------------------------- size of lot ---- (Title) -------------------------------- -- 1 ( p g , location of system in relati to wells, buildings, etc., can be placed on reverse side). �1 FOR DEPARTMENT USE ONLY r APPLICATIONACCEPTED BY---- ------------------- ------------------------------------------------------- DATE--- - --- ---------------------------------------- REVIEWEDBY------------------------ ----- - ------ ----------- -------------------------------------------------------------------- DATE-------- ----------------•-•--------------------- BUILDING PERMIT ISSUED _M------------ ----------- ----------------- ----------------------------- DATE----------------- aerations and/or recommendations:-----------------✓- I------ -- ----------------------- ---------------------------- --------------------------------- 2`-----•----- ------------------ II ------ --------- - -- -- - ----------- ..... 45 --------- 1 e� - I`------------------------------- ----------- --------- ----------------- ------------------------- =------------- ------------------------------------------- It ---------------------- ------- ------ -------------�j---------------------------------------------------------------------------------------------------------- ------ Date INSPECTION BY:-'. i --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California s ES-9 145446 Arw000 •�