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h t-y�� APPLICATION FOR SANITATION PERMIT Permit No. V� (Complete in Duplicate) • l Date IssuedS�? ,�:_,7- Applin+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 compliancewith County Ordinance No. 549. JOB ADDRESS AN L ATION..C.S1.> ......... : Q.� ��f -... ........................... _......................_.................. Owner's Neme..... ..L.1..:..... . �'ii ............... . ................................. Phone........... - Address.. / ,G ------------_.....! ---------.— ....._...._ .....-----•---•---..0....-�.-/-•.---.-.a...-.�.._1.... Contractor's Name- - - Z .. • / - -- • •• -• -• "- Phone.�Instalafon will serve: Rasde — A Apartment House Commercial ❑ Trailer Court ❑ Motel {.__•.. , nce ❑ Other ❑ Number of living units: J.__ Number of bedrooms .1.._ Number of baths /-... Lot size ......� ' Water Supply: Publics stem Y Community system E] Private ElDepth to Water.ieble�Y.,� {}, ----------- Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe 93"Hardpen Previous Application Made: Yes El No � Q3--No Construction: Yes No ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11pti Tank: Distance from nearest well....... ..........Distance from foundation......-- Material.......... ...........__ - No. of compartments.. ... Size ............... Liquid depth _______ Disposal field: Distance from nearest weII�Q/ Celt lotapacity ""' Distance from found....,, .' ,_Dwtence to nearest lot lire..47 1 �' Number of lines........1....... ..............Length of each line...... .,...................Width of trench_.. ................... Type of filter materiel.Scl7�aCr.�_.-._-,Depth of filter material -,-.--__.-Total length... -_!,_ Seepage Pit: Distance to nearest well......................Distance from foundation..............._...Distance to nearest lot line..............-- ❑ Number of pits.----------------Lining material----------------------Size:,Diameter-- .....Depth_................. Cesspool: Distance from nearest well__---__...__Distance from foundatiol(.:..................Lining material _-,--_: ❑ Size: Diameter... Depth.--- -------....._..Liquid material "- Privy: Distance from nearest well Capacity.. •-------- gels. .......... - -•------------- _.....Distance from nearest building El Distance to nearest lot line._..-_....._- g•'---`-••--••---•------................ Remodeling and/or repairing (describe):-.........._....... ................... .....•._,,,-- .............. ---------............ .................------........-................................................................. ........-.............—..... —`..................-........... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joe um County ordinances, State .{laws, and rules and regulations of the San Joaquin Local Health District. (Signed....1/.L{J,�G......�" �, (,..,._'1 tA�Q t� By:...........k ,Al _ --- --�.N -. vner and/ --••---_ --- - a Corrkae r) - - --------- - - (Titre) (Plot plan, showing sin of lot, location system in roktion to wells, buildings, ata., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. G J - ----.........---............••.. — — - REVIEWED BY---..... ... - DAT ............ ---•............................------•--•--......•...... ......... DATE..3 BUILDING PERMIT ISSUED..._.... ............... - - -..-.--------------•--•--------•--- AMerations and/or recommendations:................_.. -------•--..........*...._-•----. DATE.-. rc"------------------------------...._.. ...---------- ................_............_........------------------------------ FINAL INSPECTION BY_...4*,_,..... Q - / Date.. _$/ �.............................. ... ..-..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street Stockton, California 132 Manteca, ore Cal GM14 314 North "C" ree} fedi, California Mantaea, Califorale Tracy. California ES-9-2M : Revised W-2100