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APPLICATION FOR SANITATION PERMIT Permit No. rpt.__F-------- i (Complete in Duplicate) d /2 / Date Issued 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. 549. -, -�j JOB ADDRESS AND LOCATION........ ---- T- �/ ; - � �..-- ��` � Lc :---------- t-, Owner's Name-----------•-------•----------------•--�-----_4 # 3N-f-L-1��+��C- Phone ��f-�� 3, Address.--------------------------------------........ --.c #��-_ --------------------------------------------•----• ------------------------------------- Contractor's Name--------------------------•--------F�-l:'!_R-A.0-84-----------Z -C--------------- Phone =� -'Q Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---.J_. Number of bedrooms �._ Number of baths ._1-.- Lot size ---��_"-- I�_�-.-�---�---�-� Q Water Supply: Public system El Community system [_1 Private 0j Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay Eldobe o Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool l ermitted if public sewer is available within-200 feet.) Septic Tank: Distance from nearest well=/ r_O--;�.=Distance-from foundation _� _♦-____.Material__ - ._ �L�-----------------. No., of compartments-- --- ---- --Size --4.3",X.- 'Liquid Capacity__.--FQV--- Disposal Field: Distance from Le est,vJe11-- --_ O_ ._Distan erom lou'idafion__ 0--his ance to i ear lot line_________________ IX Number of lines-=----------- _;_.. ._Leng is of eac`"li c __x_. Widthfof #Tench-----_-------_ v - :- --��---------� t ---*------------------ Type of filter material-�4/Get _- '� iter 'a`herialy._I-----_-- ----.Total ;ength -..--_: gip." ]] .. , Seepage Pit: Distance to nearest we'll ---------- ----1- iTtance from.foundation_F---------------Distance to yea est#lot line-------------- ElNumber of pits .... ---------Lini i nate660------- -------Size: Diameter----''�---'--- DePtn - Ir' -------------------------- f e e from foundation .___ ----------- material--_ ___------------------------- Cesspool: Distance from nearest well l _..._.__Distanc Size- Diameter-1 i _ D pth_ -- --------------------------- ----�- --------Liquid Capa-ity-.-.-I---------------------gals. ❑ t r k - __ Distance from nearest buildin ---------------- Privy: Distance from Barest'well--------- - ---- ---------- - ---- l i 9; Y f _ Distance to ne est lot line--`--- 1-1----a'----------�' = :---- ---------------------------- E j� � 1 )l `' . ------------------------------------------------------ Remodeling and/or repairing (des Jribe):_...*_.__�6CJ1 ---- -- c►; - -- - -------- -� - Ti __.__________._.______...____...-.._... -------------------------------_-_-..--._.__.__________________----_-_-_-_-----_--.._.________------_-____----___-----_--_-_-_---.----_-_---__---.------______---_-_.-_.--_-_-_--.-_ here ertify that I have prepared this application and that the work will be,done in accordance 1h San Joaquin County ordinances, St a 1`ws, nd ruleF �d regulations of the San Joaquin Local 1 0 jethpistrict. ;- (Signed)--- .► ~ ( Contractor} Si ned -- ---- --------------- [ g } ' r, �i 1 �' ':`- Tale Fa-�- _�. Q ------------ By:-----_-------------------------- ---------------------- --------- ------ (Title, (Plot plan, showing size of lot, location of system in ation to wells, build' gs, etc., can be placed on reverse side]. F ► FO TMENT U E ONLY. l APPLICATION ACCEPTED BY--------#--- ---- ------ -- ---- -- ----I--------------------------------•------------ DATE-------- °% -------------- REVIEWEDBY----------------------------------- ------------�------------------- --------------------------- DATE { ` BUILDING PER ISSUED - r�: -�---- -- r ; DATE i -------- Alterations and recommendations:._.. -- I - -sem W- 14 --------- _ --------------------------- -------------------------- -------------------'---------'- OF FINAL INSPECTION BY: Date ©._.^ /1 ..... . ��----------------------------------- 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 Revised W-2100