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APPLICATION FOR SANITATION PERMIT Permit No. ..j.0.7_ (Complete in Duplicate) Date Issued ---- -__ ___ 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 OCATION____ __ _ - 1 -------------- ---------------•--- ---- Owner's Name.-----•----•- -- -. ---•----•-•-- -------- -.-- Phone------------------------------------ ----------- Address--------...-•---------• --- ----------- , �---- ----- ------•--------•----------- - Contractor's Name.............ILQ� -------------------------------• --------- - - -- Phone------------------------------------ . Installation will serve: Residence 0 Apartment House-E] Commercial ❑ Trailer Cert Motel Other [jNumber of living units: _`,$yNumber of bedrooms -------- Number of baths ------Trailer t,size __ y Water Supply: Public system ❑ Community system ❑ Private Depth to Wete�r Table -J�,.jft- Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ r Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑` NoNew Construction: Yeso ❑ , TYPE OF INSTALLATION AND SPECIFICA IONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` t Septic Tank: Distance from nearest well_: ---DistancIe from foundation__.__--0-------Mate�al__ _ __ No. of compartments______- `� Ca a Size._-f..f__sJ--fl -Liquid depth--- Disp l Field: Distance from nearest`well..--0--. �--._Distance from foundation___.__-_ __._-Distance to nearest lot line-_._-__-�_____-. ��. Number of lines_ __- _ _- L th a each line___ '� Width of french -- -------------- Seepage ------------- Type of filter material_,e'r] f2 _ /c i1 er material___j._ _ VV - Total length- .- - g U Number of pits----`r><--------Linin material- .Diameter. ttO nearest lot line__-___ ----• ee a e Pit: Distance to nearest well___ _(,9Distance from ounda#ion-_-_ - p De to y '' Cesspool: Distance from nearest well-----------------Distance from foundation-----_---------.__-.Lining material-__.--.----__-__ ❑ Size: Diameter------- --- --- ------.Depth---- .�... -..M. -�: ` Privy:.. - = Distanceftrom�nearestivell......................... _ ........... _ ❑ Distance to nearest lot line_______________________----------------------------------------------Distance from nearest building -------- ----••------------------------ ---•-------------------- ------------------------ Remodeling ---- --- • --- Remodeling and/or repairing ------------------------------• .� -•---•-------•- ----------------------------•-------------------•------------------------------•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ___r:ordinances, a laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--�- ------••-----•---- --------------- -------------------------------------- --------------------------(Owner and/or Contractor) By: -----•-----------------------------•----- ' Tale I ' )------------------------------------------------------- ` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)-. ___. FOR DEPARTMENT U_SE ONLY APPLICATION ACCEPTED BY-----------F---------- -------�^'�----------- ------------- -- , REVIEWED BY------------------------- DATE_ -------Z -•-----------------•---------------------- ------------- -------------------- ---------------------------------- DATE---------------- ---------------- .._ BUILDING PERMIT 1SSUED_______________ - DATE Altera' ns an or repo endations:- F .- - 1P. � �' , -- ..-- }} ------------- `ice 1 -------...-- ------ ---- ----- --- ----------- --- - /�j ----- - --- e - F1NAL INSPECTION BY:_.__.. ._- _tt - .N--- ---126A fe----------------- -- -'" `. -�] '---SA �W L LTH CT 130 South Amer!" Str 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California �5'--9 745446 arwooa -