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S ` APPLICATION FOR SANITATION`PERMIT Permit No. X514-__ O._0 } � (Complete in Duplicate!' .. _ �_.. Date Issue d ------- --02 0- 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 LOCATIONI__ t Owner's Name .---- .. /- - � I F ��? . ------ Phone ��' Address -y ------- -- Contractor's Name----- •-- " ------- --------------------z------------ ------ _."" Phone__ Installation will serve: Residence ff-Apartment-House ❑ 'Cornrnercial-FI`"Trailer Court [j Motel ❑ Other ❑ Number of living units: _ _" Number of bedrooms -- Number of baths Lot size ------ S__------ k-C__e___"--"""" g _ 1 i ' Water Supply: Publicsystem [Community system ❑ Private'❑ Depth to Wates Table }; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑_ y Loam, Clay.Loam ❑ , Clay ❑ Adobeardpan ❑ f Previous Application Made: Yes4. PP ❑._ No New Construction: -Yes te No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: r ):. j (No septic fanktor;cessp of permifted if public sewer is availabletwAin 200 feet.) i epti Talk:, Distance from nearest I------------------Distance from foundation__-------_I No`of compartments ' ice ' - => + te}ial .. t p -- ----- - Size----- 1 • '-- - Capacity . p ,� t � Liquid depth._-------�---• -- -_ P Y--------- ------------ - Dis 1 ield: ' Distance from nearest well-__.___-. -'Dis'tance from foundation._�___.;_ :" Distande to nearest !o} line �� Number of li,nes---- -- - d Typeor fine mate r__---'_------_: Depthhof filter�mlaterial-----I_____-.- ...Total:' r 1. .le gth_nch------ --- �------------- Seepage Pit: Distance to nearest welld�' ___-_ pistance froth fo relation _ -____.Distance to nearest lot line__-"S__".-__"" : s v ,i I�l77 umber'of pits "..=1' .-":--' _._Lining material_ Size: Diameter -_ _g_ -_--Depth" .--"'�-.-- �..+' Cesspool: pDistance from nearest well- _----- - Distance from-foundation '_- -t-" . �. Linin material -------------------- -------- -------------------- El Privy•. ... �+� D sta Diametere romnearest well-------,.-.:.,_,-.�Depth-----------�----� -Distanc --�-----�-}- .-Liquide Capacity----------=--------- ---�---gals, t - > ,. , e from.nearest b�rilding - _ .❑ Distance to nearest lot line t� _ .,. _... ------------- r i ---- i N --------- - ------------------------------------------ Remodeling and/or repairing (describe) ce �, -r ------------ ----'�--------=----------------•- ------------ ------------�-c_ "" ,t •- t .e: w ------------------------------------------------- ------------------------ _---"-..--i• ""_""""""."-_."""__""-F•---"'-------'-------'..---------"----------------------------•--------:------------------------- -"_ "-" --------------------------------------- I hereby certify that;l have prepared this application and that-the work will-be done in accordance with San Joaquin County ordinances, State4lawsand rules and regulations of the San Joaquin Local Health District. r (Signed) �� ! R. T : / I T -- ---------------------- (Owner.c and/or Contractor) ' 1 (Title) - fir- ' ( P g 4 Plo+ Ian, showing sire of lot, location .4 tem in relation to wells buildings etc., cah be placed,on reverse side}. j FOR DEPARTMENT USE ONLY._ r APPLICATION ACCEPTED BY_--.----__-_'_4-------r - ------ REVIEWED BY ------------------------------ -------------------------- -- -" 8UlLDING PERMIT ISSUED--------------- ---------------------------------------------------------------- - Alterations and/or recommendations:-------=------------- - -----":----•------------• ---------•---------- °---------•--------------------------------•--- -••=---=-- n --------: - ------------------------------------------------------------------------- -------------- ! . , -------------------------------------•----•------------- --------------------------------- -- -------- - -•----------------------------------- FINAL 1NSPECTION BY.:. -----= r _---- -------------------------------- Date '_i: " «•�_ :".------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock}ort, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100