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` APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued Application is here made to the San Joaquin Local Health District for a permit to construct and install the work heroin describe This application is made in compliance with County Ordinance No. 549, f.E'ausa 1,,,, E0r2 ��s i�,G os�/ 5f Ifs ,L(,? . JOB ADDRESS AND LOCATION__._----- _A- - �•`� l e3gyNu#�}c� sl _ Owner's Name-------- C7... / ,: � ----•�-• ---�-f_7o�'Q-- - ------------- ----- ----- ----- --- ----------- Phone- �-�1./-��------ Address------------------------- s7- r �( . �} Contractor's Name - d_�lr'1_qh.------ 1 ------------------- --------------- ---------•--- Phone------l- '4 f Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i� Number of living units: _-.�-- Number of bedrooms q ' 9 .�- - Number of baths -- -_-._ Lot size ____I__-/�C-R�-----__- ---------- ---------- Water Supply: Public system ❑ Community system ❑ Private g- Depth to Water Table 2St.4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay .—I dobe k Hardpanf[1� # Previous Application Made: Yes ❑ No N New Construction: Yes D< No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)[ ' Septic Tank: Distance from nearest weltDistance f om foundation--lf i��f ----- ----------Material---��_'------------ ------- No. of com artments-_- ._-__._- Size.1___'__ _ '• �� ! p -a�____-Liquid depth._457.�-_________-Capacity__ P."M1___� Disposal Field: Distance from nearest well 0f---Dista Distance foundation-_--L 2`-.-.Distance to nearest lot line----- 7 Number of lines------1--------- -----------------Length of each line-_-- _ �� gc ---------- Width of french �` of filter material-_-�-_��r_R1�----Depth of filter material-------1-e,--------Total length---- Type --- --------------------- o neare t well-_ 4P_0_!------Distance fr fo ndation'7-S"" ___-_pistance to nearest lot line-----1�_ eepa a Pit: Distance of pits---- -----------------Lining ma#erial__�t- - _ -Size: Diameter_. _ -,�if_--.Depth----�-o9_--------__-- ---- Cesspool: Distance`from nearest well-----------------Distance from foundation--------------------Lining material------------------------------❑ Size: Diameter------------ --------- ---------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest buiidin ❑ Distance to nearest lot line--- g Is, ` Remodeling- and/or repairing;(describe)--------------------------------------------------------------------------------------- -------------------------------------- ------------.. ------••------•-------•---------• ------•----------------------- ---------------------------------------------•------------------ -------------------------------------------------------•---------------••---------•------•------------•----•---------_------------------•--- ---------------------•-------------- --- ---------,---- ----------------- -------------------•------- I hereb ,certify f I have prepared t is plication an that the work will 4e done in--a--c--c--o--r---d----a----n---,c---e-------w------i--f--h---- ccordancewith San Joaquin County ordinances, St , anted rulesnd regula 'o s of t e—Sa oa uin Local Health District, (Signed) -- i By:------•----•--•- ; ( } ntract 0 or] Title l�?7F ----------------- 4 __ _ (Plot plan, showing size of lot, location system in relatio in ---------- g , etc., can be reverse side]. 1 � DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY---------------------- - -- ---------------------------------------------------- DATE----- ------------------------------ REVIEWED BY ----------------------- ------- DATE--//-"�� BUILDING PERMIT ISSUED-____'--•- ---- ------------------- DATE - ----------------------- ----------------------------------------------------------------------------------------------------------------------------------- A+orations and/or recommendations------------------------- - --------------------------- I i ---------------------- -----------------------------• - -- ----- ----------------------- FINAL INSPECTION BY______ _ - -•-------- - --- ------- ------- - ---------- Date------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-21DO