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� � APPLICATION FOR SANITATION PERMIT Permit No. Alt l.. (Complete in Duplicate) Date Issued A Thipplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with )County Ordinance No. 549 JOB ADDRESS AND LOCATION_____- - _ �.- - -- Owner's Name------ 9_pL°ex ' _ - - ---- - ------------------------------------------------ --hone-- Address_________ - } Contractor's Name____ -= � � Ph r is .r I - - --=-------------------------------------------- Phone------- ------------------- - Installation will serve: Residence artmenf House ACommercial'. e ------J-i P ❑-� Commercial.,❑.',Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/__ Number of bedrooms - _ Number of bathsE---r Lot s ze Water Supply: Public system { }"Community system p Private [❑ D'epfh to Wafer Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-El-,Sandy Loam ❑ Clay Loam ❑ `Clay ❑ Adobe 9-"'Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes [� t`lo ❑` FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or'cesspool permitted if public sewer_is`available within 200 feet.) #p,,a nk: Distance from nearest well______.:.__-____Distance from foundation____________________Material______._____--.-_.._____ _.-____-____-_------ ! No, of compartmenfis_____. t- Size-- ------ ------ -----------Ligilid depth--- ------ ----Capacity- -- nearest - ------------F Id: Distance from nearestefi_. -_---Disfance-from 'foundation 1fQ �_=__Distance to nearestl t line Number of lines—_77 �__' Len th_of each-fine _ Pf Width of trench._______._ ------------- Type of filter material __ __Depth of filter material__--,��__--------Total length_------ __�-_-__ Seepage t: Distance to nearest well------- --___-Distance from f ndation____ _________"_. " \ + �� b�an�ertonearest..lotiine___�-�--_---- ® Number of pits------/------------Lining material_ _ ___ Si,,:_ Diameter____..a-.- ---------Depth____ -.-___ Cesspool: Distance from nearest well________________ Distance from foundation_______-_________..Lining material------------------------------------------ 171 Size: Diameter------------------------ -------------Depth------------------------------- ------ l ------------- --Liquid Capacity----------- ---------- -- -gals. Privy: Distance from nearesf well-______________________________________ ---- ---------------------------------------------Distance from nearest building-------------------------------------------- -0 -------"----___ Distance to nearest lot line________________.__-_ __ __ --------------- i ----------------- -------- ^---------------------------- --------------------------------- Remodeling and/or repairing (describe):------------------ ---- ---= !"rs = :-------- FROM------- _�. T = x�-rum. or �o, Dl _ 1?_SrrP_ - ?_lG- QIP AQ1_( P_I1 ---------P�Q_ T ---------W -1-C-0--------wa-s------- If [ ----WT1s.._90-T---�r[D� I L�------� #-_ln4__ I hereby certify that I have prepared this application and-that_the work will be done in accordance with San Joaquin County ordinances, State laws, and?r1es and regulat'ons of the San Joaquin Local Health District, . � f (Sined 9 ) w� --�- ---------- Contractor) --- -- -------------------------------------------------- BY: ------------------------------------------------- ------------- Title (Plot plan, showing size of lot,'location of syste n relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY----- REVIEWED Y.---ED BY--------------------------------------------------------------------------------------- -------------------------------------- DATE BUILDING PERMIT ISSUED ---------- -------------------- -------------- DATE - ------------------------------------------ ----------------------- _ ___________________________ k Alterations and/or recammeyn•�da_tions:-__-_-__._._-------- � _ ---------- /� ex -•v--- --------------- ------------- - t�-O_f=-•-------- '.=•-5---------- D NI BY• ----- - --- - ---O --- ate �7/ FINAL INSPECT�b- ✓s ----------------------------------- ,; SAIV JOA QUIN LOCAL HEALTH [?ISTRICT� � f 130 South American Street 300 West Oak Street 132 S cemore Street ./ Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2K4 Revised 7.57 F.P.CO.