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APPLICATION FORx.SANITATION PERMIT � Permit No. ..____.. (Complete in'Duplicate) i/�7/ Date Issued �-f->x-------- 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ -7'�� ---- -----= ------------------------ �+ - -------------------------------------•------ ------------------------------------------ Owner's Name - - -- --------• ------------------ --------------------- P =--1_ � �✓ ` Q Address-----Z-7 L)---- ----- ------------------------------ -------- ----------- Contractors Name---------- ffc Q Phone �d-./.2 f Installation will serve: Residence Apartment House-❑– Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: _�x Numb`_er of bedrooms __p�2_ Number of baths __/_ Lot-size Water Supply: Public'system ©�ommunif s stem <P�iv�ate # y yy ❑,. ❑- Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I]--Hardpan ❑ Previous Application Made: Yes ❑ No �ew construction:lyes R4�6 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitfed if public sewer is--available within 200 feet.) F e ic.Tank: Distance from nearest well________________Distance from foundation------------------Materiai__--____-_____.________--___.________'._______- 0� - _. No. of compartments ----------Size---- ----- -------n.......Liquid death-------------------------Capacity-=------------ J11 1� Disposal Field: Distance from nearest well.//.- '.Distance from foundation___iIFA.____Distance to nearest lot-line---2_4.... .. _�Len th of each line________ 4 i .2 Number of lines----------=----------------------- g �-- -------;;_----.Width of trench of filter material%t + aG '__ADepth of filter materia!__'°_ -_+��__:__Total length____-?d__-___________________________ .. �-5. may,,- sr !� - '.' �;._ Seepage Pit. Distance to nearest*well_;2,f ., ___Distance from f undation-_�'�E_ Distance to nearest lot line___ ©/ Number of pits------ _. __:_Lining materialQ�__�o .Size: Diameter__-3_V_____:______.Depth___._ s_-�___-_>________-- r IL Cesspool: Distance from nearest well----------------- *om foundation............ .......Lining material_:- ----.____.._______-_____________- ❑ Size: Diameter- I-----------_.- -"''=`==Depth _---Rrz----------- ----:-----� Liquid Capacity----------------------------gals. Privy:. Distance from nearestlwiell__ _ _________r-- -D1stance4romtnearest building-------------.___---_____:____._______._. ❑ Distance to nearest lot line_------------------------------- - Remodeling and/or repairing (describe):----------------------- ----------------------•--•-•--=--------------------•----•----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ t,; ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- --------------- -------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, a ule, and �regulaffions of fhe San Joa uin Local Health District. (Signed) /r -- . . :-- 7 (O . er and/or Contractor] By:----------- �?5- . .r - ---------------------------------------------ITitl (Plot plan, showing size of lot, location of sys efh in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ------------------------- 1/56-,_. DATE.--------- 1-- REVIEWEDBY------------- ----------------------------°---------------------------------------------------------------------------------- DATE-------------------------.-----------------------.......... BUILDING PERMIT ISSUED-------------------------- --------------------------------------------------------------------._.._. DATE..---=-----f--------- ------------------ Alterations and/or recommendations:-------- ------_-- _ --•__-------.--•-•-------•--------------•-••------•--- --- - - - -- - - ------ - - ----- --- - ------G�/! 7_..---- .5; 1� --- tip---- ---------- ---- - -- ----- ------ - ----- - ------------ -- -- - - ------ -------------- ----------------------------------- ---------------------------- ------s-------,/---W---t-,-- ------------- ..............._1------------------------ ------ ° FINAL 1NSPECTlON BY----------- ------------•---------- ---------- -------------------•-------------------------------------------------- -- -- - -- ------------------------------------- ------------------•----------------------- -- - ll '/ 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 t —9-2M : ' Revised W-2100