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( APPLICATION •FOR SANITATION PERMIT Permit No. ._�,� -Z�... (Complete in Duplicate) 9 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const uct and install the-work herein described. This application is made in compliance with County Ordinance No. 549. dz000 Ate @ pp �� / JOB ADDRESS AND OCATIQN-- a..?s �dqL..-1 --I ..........-�4_-_�h�t &/.`.t---/a`�le ' �J Owner's Name--------- . ` Phone* ' - ----- --- Addressc '. Contractor's Name .. f `f'. "�� - �/G ----- f hon Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other/{❑ Number of Living units: __I____ Number of bedrooms J----- Number of baths__1--_ Lot size ----k.49 �__ ___________ Water Supply: Public system ❑ Community system$—Private ❑ Depth to Water Table ._..._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYP OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ti k: Distance from nearest well_________________Distance from foundation....................Material-.-__-_-__.__-_-_-............................. No. of compartments-------------------- Size--------------------- ...........Liquid de,►pp►th - ---- ------------Capacity_----------------•-. iel Distance from nearest well./P?0_r__._Distance from foundation____�s ,....Distance to nearest lot 1ne--- ....... Number of lines- !_____ _________ ________Length of each line- 0.�rL�"_�A-%j,�.-Width of trench-.-__�,1�..'-� ___,.. r . 4- Distance ype of filter material___.p_t4�____Depth of filter mate ria l7�,,_.Total length_/CQ!_ __ � .0 T Seeppe Pto nearest well___________________--Distance from foundation._..................Distance to nearest lot line__._:_-__.-____- umber of pits----------------------Lining material-----------------------Size: Diameter______ ___. -___-__-Depth--------------------------------- Cesspool: . ._ -_ :. ____.-_--__-__.- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----____--.__-________:_____--_._-- ❑ Size: Diameter--------------------------------------Depth---------------- •---------_Liquid Capacity-- -•------._--- ---•--...gals. Privy: Distance from nearest well------------- ---------------------------------Distance from nearest building-----------------------.------------------ 17-1 --_-____- ._-__.❑ Distance to nearest lot line------- -- ------------------------------------------------------------- ------ ---- ----------------------------------------------------- Remodeling and/or repairing (describ ----------- .. .--:-------------- - --------- .. ------------------------------------------------- -----------------•-------•--------•-----------•----------------------- --------------------:-----------------------------------------•----------------------- ------- I hereby certify that I have prepared this application and that e w k wi be done in accordance with San Joaquin County ordinances, ate and rules and regulations of the San Joa in Lo I calf District. (Signed)...... -4. W ........ 1� ---.9...1-_r..-- -y-- ---- --- --- - ----------------------------------- Contractor) By:-------------------------- ------------------------------------------------------- _.(Title)........7=777=----------------------------------- (Plot plan, showing size of lot, location of system in.relation to uildings, etc c be placed on reverse side). FOR DEPARTMENT USE ONO APPLICATION ACCEPTED BY------------------------- - -------------------------------------------------- ---------- ------------- REVIEWEDBY--------------------------------------------------- --- ---------------------------------------------- DATE---------- --- J v-----/----•------------- BUILDINGPERMIT ISSUED---------------------------- -------------------------------------------------------------------- DATE------------------------------------ •------- Alteratiops and/or recommendations:... ----- ----- - 1. -- --------- /" FINAL INSPECTION BY:. ------ --------- ----- Date------.--,7 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.