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XX ` 1 APPLICATION FOR SANITATION � PERMIT Permit No. .__�_ ...� (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 com liance with County Ordinance No. 549.1 t5z-2 103-.tJ('7_0 Z9 JOB ADDRESS ANIOCATION �GZ E - ------ C( " _. Owner's Name__________________ - -�•�-------- �4_�.__t_ --------- ---------- --------- -- ---- Phone--- I � F Address ------------•-•--�------• -•---•--- /t/C S'�" U' _ �.--�4G ,Cr A ----------•---------- - - - -----------------------•----------- Contractor's Name __ �• ------------------•-------------- ----------------------- ------ Phone. •= Installation will serve: Residence ®apartment House ❑ Commercial ❑ Trailer Gourt ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms ----tNumber of baths _ --- Lot size Water Supply. Publics stem PP .Y' y ❑ Community system ❑ Private E?-15eto Water Table —4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ZW�Iay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 91- New Construction: Yes` ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub is sew r is available within 200 feet.) f � / Sep is ink: Distance from nearest well___ "��"b fes' istance from foundation__.__ --""__.Material______!`."E_"( "" Ee,I p No. of compartments._-__ ___ rLiquid ------ - - - __ Size-_-"-- - -•.�'d'! '.4de ----Capacity-.9L�d-- Dis 5sal Field: Distance from nearest well...-__ Y-"Distance from foundation-___j______- Distance to nearest lot line______________ Number of lines______.__ ' ength of each line-------------f"4?-- "--.Width of trench-------------1'-�. i-f_ Type of filter material. ----- pth of filter material_-__.__--t,2 g `–r ------.Total length - a i eepage Pit: Distance to nearest well------_---------------Distance from foundation__...------------_Distance to nearest lot line-------------___- �} ❑ Number of pits---------------- -----Lining material__.--------------------Size: Diameter--.----------. ` ------ Cesspool: Distance from nearest well--------------_Distance from foundation._.___-""_-__"._--.Lining material______________-__.______.•"-------- Privy: Diameter--- --------- --- ----- ------.Depth------ ---------- ------------ ---- - - -- ---- Liquid Capacity- --------------------------gals. Privy: Distance from nearest weli_..__.._.f__--------------------------------- --Distance from nearest building------------------- Distance to nearest lot line_________________ Remodeling and/or repairing (describe)---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------__" -------------- -----------------------------------------•---•---------------------------------•---------------•------------•-------------------------------------•-------•----------_-•------------------- ----- I hereby certif hat I have prepared this application and that the work will be done in accordance with San Joaquin County es.,*Stat ordinancand rules and regulations of Ahe San Joaquin Local Health District. j .•, (Signed-------- By: - r_ �__- ____"_.._._-_.(Owner and/or Contractor) $y:._.. ------------- Title - - ---------------- - - - - ------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). L FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..__""_-"__."-_.-""__- REVIEWED BY -• -------------------•----------- DATE --------------- -- I- Fl- --• --------f ------------------ ---------------------------- ---- --------------------- ------------------------------------------------------ - •-- --------------------------- DATE BUILDING PERMIT ISSUED------------------------------ -- ------------------------------- DATE.-------------------•---------- - - Alterations and/or recommendations: -- ----- ----- ------ - --�.c� - -�Q_. Bier ---- -1 - 1 � - 1 �A1 ``f = =- _ +044 FINAL INSPECTION BY:.._' .--- ------� Date... _ � '� ------------------------------------ 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 Et-9-2M 145445 ATWOOO 12-54