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APPLICATION FOR SANITATION PERMIT Permit No. rI� (Complete in Duplicate) A A her Date Issued ------- plication is her y made to the San Joaquin Local Health District for a ermt to construct and install the work herein described. This application is made in compliance wgill county Ordinance No. 541'4' JOB ADDRESS AND L=� T) U - ----- ------------------------------------------------------------------------- Owners Name 419-!-.0 ....... ........... ------------------------------------------------ r -------------------------.-- Phoneff ,. _7� lt�----------------------------------------------------------------------- ---------------------------- Address--- I Contractor's Name________________._______.__._- ---------------------------------------- ------------------------------------------------------------•--- Phone Installation will serve: Residence KZarfmenf House [:] Commercial ❑E] Trailer Court E] Motel [-] Other Number of P I I Number of living units: -1 1 bedrooms of-66%,_ Lot size Wafer Supply: Pu51�c-s-y7sgm—EI-C—�7- sys�; f m Ej-Private -b7 - ommunj Depth Water -fZ_16A:5_ft,_ San'd, Character of soil t1 a depth of 3 feet: ravel 0 Sandy Lc;;P' Clay Loam E] Clay E] Adobe 1 0 L' a'-Hardpan E] Previous Application Made: Yes-El "FNe -onstrucfion: Yes No E] 1 4 1 WIC TYPE OF INSTALLATION AND SPECIFICATIONS-' (No septic tank or cesspool * pool permitted if publit sewer is available within 200 feet.) 1. 1 SQpfi jan]<: Distance from nearest well 4----t-----Distance from foundation__.___-_-----------Material- PT' No. of compartments--T ------------------ -------------------------- --------- ------ ------ ize--------------------------------Liquid cle th-------------- 1i k, -P ---------!-.Capacity Dis osal Fie d: Distance from nearest well_..-__.___-----Utan(�difrom foundation___________-__ Distance tAearest lot line F1 OF Number of lines � 0 "11 1 11 -------------- -------------- --Lenijit�lof each line -----------------------Width of french Type of filj ��ferial_ ------- length'------------- . --------------- A ----------------- ---Depth J cuter material- T Seepaq ai,� Total - ------- of p! Distanc9ito 'nearest lot line_ 6 Pit.: Number on ------- Distance to nearest well---- -Z-----------Distanclfrom fmndafi pits___ .___ ----- ----- Cesspool: I -------fi-Lining material ---- ----Size; Diameter--------Z4 --------Depth-------Z-O ------------- Distance from nearest well________ _ Distance from foundation I - Ej Size. Diameter----I--------------- Depth -------•-------- .... Lining matefial--------- ---------------------------------- ----------------------------- Privy: Distant `n`c`e`,r -- ----------- Liquid Capacity---------------------------gals. `from D1_Wr�c_eG_m nearest I ❑ Distance to nearest lot line------------------------- --------------- ist, airest building,---------------------------------------- -------------------I------------------------------------I------ ----- ----------------------------------------- Remodeling and/ (-d; A .1 sZz 70'e')77 --------------------------------- ---- --------- ---------------- - --- ------ -—-- --------------------- ---------------- --------1_(�- --------)--------------------------- ---- ---------------------------------- ...........------ ---- -------6i A ---------------- - ------------------------- - ---------- ------- -------------------------------------------- -------------------------------------- 1. V--------------------------------- ----------------------I----------------------------- ------------------------______-______I hereby cert y that I have prepared this -aAlication and that the work will be done in�4cordance with San Joaquin County ordinances, State ws, and rules and 'regulations of the San Joaquin Local Health District. (Signed) ------------------------------------------------------------------------------------------------------------- ner and/or Contractor) By:---------------------------------------------*--------------------------------------------------------------------------------------(Title)------------------ijo (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -___ -_ ------ ---------------------------------------------- ----------------------- DATE1 BY----- -------------- --- -,V- ----------------------------------- -------------------------------------- DATE----::%.------------------- -------------------------------- REVIEWED BUILDING PERMIT -------------------------------------------------- - ----------------------------------------------------------------------- DATE------ `;� Alterations and/or recommendations --------------------------------------------------------------------------------------------------------------------------I----------------------------- -------------------------------------------------------------------1--------------------------------- ------- - ------------------------------------------------------------------1. --------------------------------- --------------------------------------------------------------------------------------- I-------------------------- -----------------------------------------------------------------------------------------------------------------------------_ -------------------------------------------- -------------------------------- -------------------------------------------------------------------------------------------------------------------- ------------ ------------- -------------------------- - --------------------------- I -•--•-------------------:--------------- ------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:-------------------- --------------- Date------- - -- -- .3 i --------! ------------------------------------------------ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street' Stockton, California 814 North "C" Streef Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100