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APPLICATION FOR SANITATION PERMIT Permit No, ...1�.��_.4.. 'i (Complete in Duplicate) y� 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 mode in compliance with County Ordinance No: 549. t JOB ADDRESS A LOCATION I .._[_34.8--._-.-t. --- b•j!.l , -----��d_.... Owner's Name..... 1 Phone_ :: -_ ,v Address-------•--...--•--------•'-•-• •-----•---• - � - - - ---- ---- - _ •---.. t 1 Contractor's Name.... ............. __724. ' .. .RC-- _C�li- -•--- ��- Pone :_ --.�1�� Installation will serve:'ti Residence Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel,❑ Other ❑ Number of living units: __- - Number of bedrooms-------- Number of f ....___ Lot sire ...... ... .................... 1 Water Supply. Public system ❑ Comrriuroi system ❑' Private • Depth tb'Water Table .::..... ft. ' Character of soil to e4depth of 3 feet: Sand ❑ Gravel El Loam[:] Clay Loam ❑ Clay ❑ Adobe ardpan Previous Application Made: Yes ❑ No ❑ New Construction: Yes No ❑ C] FHA/VA: Yes ❑ No ❑ . TYPE OF INSTALL ON AND SPECIFICATIONS: (No lc tank or'cesspool permitted.if public sewer is available within 200 feet.) e is :• Distance from nearest,well...............'Distance from foundation--------..1.........Material..... ----------- No. of compartments.............. ..`...Size ...... Liquid dep i_._Capecity._ sal Distance from nearest well_ .. _ Distance from foundation_:_/-_ ___...__Distance to nearest lot line--- Number',of iines•.:� :t tt.. •Length of eacl�Ii' t—I.Q:__t...._••.__..Width of tr'ench.'c _�!.--_________ I r • i"4._.. .' D. ------------ Type of filter material' Depth of filter material_�: :.��-__._..Total long+ .:/Q-•_r_•.-__•.•- • , / :... t ag it: Distance to nearest well_/.2p_•.._-•`_Distance from foundation__/.�."-..ply# ce fo°nearest lot N;mber of pits------1____.___�t.Lining mateiiai._ .,o G1Foundation ------Size: Diameter-__. .......Depth...Z ..!---- ........__"�I Cess ool I p . 4Distaince from nearest welly__._,.-:._..__Distance from ....'.._._._'._....Lining material........................... ____________ J Privy: Size Dii me4er_ _`...:..... L-'..._y Depth;- -•------------- -•............ Liquid Cap city- ................gals. y: , Distance from nearest well.i._... ...:................ .........Distance from nearest buildin ❑ 'Distance-f6 nearest-lo+•line_.__..... " ..."''7e"""""y"'• •• ..{ ••-------.•- _••--- :_..._..... ..R Remodeling and/or 'repairin describe): ` n i4i -----........... r---- ---- -- ----------------- -4 herebyy ►y that I ave prepaied his-arication and +Ilat.the-work will b done in accordance with San Joaquin County f. ordinan S+ aw d rules and regulations��••�off-the San Jo quin�ocal Health Di ' t. r 4 /1 / (; -__ (Signed) ° �66r Contractor) By:......................................................... .....................---• ...... an be placed on reverse side). E ' DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY----:--i...._:....•--•--------• --- DATE.... .../_...Ll . rpt_._.._--- • - - -------------- REVIEWED16Y..... ..................... ..... . ..---••--------••'--•-•---•••••. •••••• .. �. - __ DATE...... •-------�•••---•----•--•- BUILDING PERMIT ISSUED1- .................................- --------------- DATE------ ----•----------------•----- Atte ations end/or recommendations:... - ------•----••--------.-------•-•---•" --------------------•-----•-••------------•--•------- ------------- ( o 1 f Q" ..,. ....= ................................................................ i ' `... .. ........................ ......... .............----------------------- ........................... � .......................... --------- c............................... r I FINAL INSPECTIO .. - - Date:.._: l-•- - ~S_. .: ....... .. SAN JOAQUIN LOCAL HEALTH-DISTRICT 134 South American Sheet 300 West Oak $frost 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M . Revises 1.57 F_P.CO_