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(� APPLICATION FOR SANITATION PERMIT Permit No. ,'�� (Complete in Duplicate) Date Issued -------- � V --------- ""--� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafiori.is made in compliance with County Ordinance No. 549, s JOB ADDRESS ANC ION-------6_23— 1j_ r i•i---------- ------- -- Owner's Name----=-- -- -•---- ---------- �- -�-- —Phone ane- ----------- �---- Address------- ---�. --- -------------- ------•---------------------------------- ----•-- ---------•--------- Contractor's Name---------------- ---- ----------------- Installation will serve: Residence E�partment House E]-- ❑-� Commercial ❑ Trailer Court Motel ❑ Other Number of living units: _Number of bedrooms•_a Number of baths __ - Lot size _,,IZT-�--"R��_�--�------- ---•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table!'q_ft Character of soil to a . depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay: Loam ❑ Clay ElAdobe Eq-11lardpan E]Previous Application Made: Yes❑ 'No'Rj—`New Construction: Yes ❑ No"'Ej---_F_HA/VA: Yes [INo ElTYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Distance;from nearest weiL_______________Distance from foundation________-________.Material_"___________"_.__._ Ilio. of c''ompartments Size ---•----- ------------- ------------------------Liquid depth--------------------------Capacity..-- ------------- os Id: Distance ?rom nearest well------------------Distance from foundation-----'-------------- to nearest lot IineJ___________--" Number of lines----------------""--- -------- -_Length of each line----------"---- - O -----------.Widfh of trench-------- k! 9r�P t: filter materia!---------------------"---Depth of filter material ---Total length------------------------------------ t Type / J Distance�fo nearest well ___-_--__ Distance m f nda}ion__I -------- to nearest lot line__ •�Q____ � Number of pits.__-/--------------Lining material_ �� i /,, ----Size: Diameters Depth _�__� Cesspool: Distance;from nearest well _--_ -Distance from foundation._-........___.Lining material_________________ ❑ Size: Diameter_____.--------- --------------------- Depth .---- --- ----Liquid Capacity_ Privy: 1 Privy: Distance from nearest well. ------------------- Distance to nearest lot line_ Distance from nearest building_ ,. ----------------------------- Remodeling and/or repairing (describeJ:_______--____ --------------------------------- 1 ,; ----=------------------- ------=----------------------------------------------------------------------------- --------------------- =' ------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereb certi that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; �fa a laws, an ries and re ulations of the San Joaquin Local Health District. t (Si ned /�AL1 t� t I 9 L MI. -1 --- - ---- ---------------- -- Owner and/or Contractor) (PlotIan, showing size of lot,hloca+ion of s stm in rale+ion to "bu " � 4 " (Ti+Ie)___________ ___ ( p g buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___"_"-_ ------- "" } DATE - ----------------------------------- ------- : DATE-----�4-- BUlLDING PERMIT 155U "-----""-"- " ---------------------- ---------------------- --------'-------- -------- -------------- ----------- --------- ----------- -{DATE_ ------------ -------074-t-sa ------_-- - -------- -------------- A terations nd/or rec mme dations:______""_____._._. '— ...... ; ------ -- - ---------- ---------------------------------------- ---- ----------------------------- , A ---------- - --------------------------- 1 - -V"7�� ------- _ --------- ---------- - ---- --- - - ------- - -- ------------------------------------ ---- -- ---------------- _ - -------------------- FINAL INSPECTION BY:..__ ✓ - --'-� ---�•---• - ------ - ------- Date-- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, -California ES-9-21x1 , Revised 1.37 F.P.CO. I