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AI'fJCATION FOR SANITATION PERti�`, f. Permit No. .-_ :__; (Complete in Duplicate) 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. JOB ADDRESS AND OCATIO - _- -__ �.�,.�,_--�,( 4 Owner's. ame---------- i Phone-------------------------------- - Addres f- ------------- --- �-i� ` `�"` ,Contractor's Name PAY'#" J--6-fiT---_csl__.--�-�----;�CV_CA------------ ........ Phone:_ Installation will serve: Residence ❑ Apartment House ❑' Commercia —'Trailer Court ❑ Mo I ❑ Other ❑ Number of living units: -- ----- Number of bedrooms -------- Number of aths -------- Lot size _ _____ ____________________ Water Supply: Public system ❑ Com pity system ❑ Private Depth to Water Table ' � ft. Character of soil to a depth of 3 fee . Sand [:1Gravel [—] Sandy Loam [—] Clay Loam El, Clay El 'Adobe Hardpan E]Previous Application Made: Yes No ❑ New Construction: Yes ❑ No - FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tank- , Distance from nearest well-----------------Distance from foundation--------------------Meferial___________--____________-_-________________-, No. of compartments--------------------------Size------------------------------..Liquid depth-------------------------Capacity-•------------- ------ s'Al d: Distance from nearest well,_______________Distance from foundation--------------------Distance to nearest lot line-_______-_- Number of lines-----------------------------------Length of each line----- ___------------------Width of trench----------------------------------- Type ----------•--------- -----_Type of filfer material--------------- Depth of filter material-----------------------Total length------------------------------------------ rorri e Pit: Distance to nearest well_ Q ----Distance fro foundation_JV_ _____.D- tante to nearest lot line--- - ----___ Number of pits---____________Lining material_ ____.__Size: Diameter_.___ I,I Depth ,) Cesspool: Distance from nearest well------------------Distance from foundation--------------..___.Lining material___.___-___.--__.___.__-__--_________. Q Privy: Distance from nearest well---- --------------- ---------------Distance -- -----Liquid Capacity---.:----:------------_--•--gals. ❑ Size: Diameter------------------------- ------------Depth------------------------------- #rom nearest bAinild -------- ------------------------- ❑ Distance to nearest lot line--------- - ---------------- ------------- ------------ ---- ------ -•-- -----------------Remodeling and/or repairing (describe): _-- ---__ ,,---------------------- ----- .------ ------------•------- ------•-----•------------------------------------•-------••-•---------------------------------------=---------------------------------------•-------------------------------------------------------------------------------------------------------------- -------------------------------- ---------------------—--------------------------------------------------------------------------------------------------------------------------- ----------- -------•-------- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws, and rules and regulations of the San Joaquin Local Health District. t 1,'`'`��'` Z_ e� _ _ � Contractor(Signed)- - 1�C-F--�'hL�A�----- ��G--�11x�1 - --- ---- -- -- - ------------------------ - By:-------------•----------------------------------------------------------------------------- - (Title)---------------------------- -------------------------- (Plot plan, showing size of lot, location of system in.relation to w , buildings, , can 6e placed on reverse side). IN, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ - _._ DATE------ , =- REVIEWED BY------------------ ----------------------------------------------------------------•- -------------------------------------- DATE------ --------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:-------._. - -- ------- ------------•---------------- --- i- ------ �'-r---.----i IT-H---------- .- I _Ctf 01�------�)_�_F---------- �- ?,.f`� --------------------------------------------------------------- ----=------------------------- ---------------------------------------------------------------------------------------------------------------------------- - -1---------------- ---- -------------- --------- ---- ------- t J----------------------------------------------------------------------------------------------------------------- FINAL INSPECT•! BY:-- -- -'' "C Date -5-7----------------------------------------*,_5__�_?�_,A 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 E5--9-2h1 , Revisal 1.57 F.P,CO.