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APPLICATION FOR SANITATION PERMIT Permit No. ` (Complots in Duplicate) .# Date Issued4_0i E+ 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 LOCATION---L+f ------------ ----- ... _ Owner's Name------- _ft?---------- .. �' L Phone Address - !--------�--+ ' --=�- ----------- Contractor's Name A,-x - _�_s_"--------•-----r ev-e-1----------------------------•--•_-------------•-------------•-------- Phone-------------------------- -------- F Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____I_ Number of bedrooms ___" —Number of baths _-1__ Lot size ___7�_-' N -l Sw r Y Y ❑ ❑ p • -------- ........----------- Water Supply: Public. system �Communit system Private Depth to Wafer Table ---_____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.❑ Clay ❑ Adobe B--Hardpan ❑ Previous Application Made: Yes ❑ :No [I.,-New Construction: Yes Rg—ke-0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ef Sept'T nk: Distance from nearest well_-//O� Distance from foundation_,J_O_-.•.l .Materialp�---------------------------------------------- Liquid _ __-B/��iC i/ ______________ No. of compartments------- i _ _._,._$ize._ - ----. _, Liquid depth;---._ --------- Capacity__- -- --_.-- -- Disposal r Field: Distance from nearest well.-7✓0��t-Distance from foundation_____1.0__„:_.Distance to nearest lot line____..2- Number of lines----------e-.A!��-_____,___Length of each line__________.a ---.---Width of trench___._ - /--��---------------- �� ,, Type of 'filter matenal__ -__.SSR___Depth of filter material---_I9-__------'--Total length---------fid_•- ---------------- See a e Pit: Distance to nearest well. p_f� -Distance from foundation___ IL-V p_ g - -- � ___.___.Distance to nearest lot line______ Number of pits--------r_....__-_--Lining material----91 6;!_X_ ,.Size: Diameter-r---. ' __-Depth------ _-E-- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation----_-_ ----------------- material---------------- ------------------- ❑ Size: Diameter.,-=f------------------------------Depth------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________________ ______Distance from nearest building------------------------------------------ El --------------- ❑ Distance to nearest lot line--------------------------------- i1 -• -- ---------- --------------------I------------------------------------------------------- Remodeling and/or repairing {describe):---------------------- ---------------------•---------• -------------•----------•----=------ •-----------------•----------------------•-------------------- ---------------------•------------------------------------------------- --------------------------------------•----•------------•---------------------------- r ------•---------•------------•------- ----------------------------------- -----------------------------------------• -------------------------------------------------------------------------------------------- ----------------------•------------------- --•------------ 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 rules and regulations of the San Joaquin Local Health District. (Signed)------- (O r and/or Contractor) By=---- (Title} -------------------- + (Plot plane showing size of lot. Iocafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a { APPLICATION ACCEPTED BY----- --- --------------- \ --- ----------------------------• ------------- DATE_ _ Ce REVIEWED BY-------------------- -- `��- :_ DATE `J� ------------•---- BUILDING PERMIT ISSUED = DATE------------------ -e ------- ---- Alterations and/or recommendation's: ------------- -------- - --------------="- -----•------- - `� ------------------------±•----------�.�------�^ -------- ` ff' ------ :•- ----------- �, -;-- ----------------- ----------------------------------- - ------ - A------ r7- ----- - f �+` } f c^-�+! d r• •-.)--�----------L----r__.._--- =' - ----•- --------------------- ------� --------- ------Y-------`- M y f I A-- -----------------------------------------------------------... -••-----•-------- � - --------- FINAL INSPECTION BY:--- -- _ =- ' °� Date------- = �"�= �`� x1 ” �. .. ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California E5-9-2M 145-6 ATWQU. 12-54