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APPLICATION FOR SANITATION PERMIT Permit No. ____13_._ .r-___ y G (Complete in Duplicate) - Date Issued ________��S-_� 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 Ordina ce No. 549 ] ; -...- JOBADDRESS AND OC N----- ------- -------------- -----• - - - ---------- ----.....•----------------------------------------------•------l--/--r/ Owner's Name-------�--------- ----- -------"t---•-• ----- ------- ------------------------------------------------------------------ PhonelT _Sr �yT-�X ��{Address--- - --- --•--------- -- --------- ---- - •---- - --------------------------- ----...---`•--�--------------------------------------•----•-----------•---------------------------....... Contractor's Name------------------------ - - - • -----e----------------------------- Phoney-�-~��D Installation will serve: Residence ❑partment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units:__ Number of bedrooms ./_ Number of baths .;/___ Lot size ----_�Ta___ ----- ______----------------- A Water Supply: Public system ---Community system ❑ Private ❑ Depth to Water Table Water Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam E] Clay E] Adobe❑ Hardpan ❑ a Previous Application Made: Yes E] No New Construction-: Yes ❑ No L� y TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I 4r)o,41-Fi tit k; Distance from nearest well------------------Distance from foundation__._______________.Material-------------------------------- .__-_------_____. c� No. of compartments------------ -----------Size------r---------------•-------Liquid depth------------------------._Capacity------------- ---•-- Id: Distance from-nearest wefi----------_______Dist ance from foundation--------------------Distance to nearest lot line_______________- ya Number of lines------------------------------------Length of:each.line--------------------------------Width of french----------------------------------- Type of filter material._____________________Depth-of filter material-----------------------Total length------------------------------------------ Distance it- Distance to nearest.well.l��---Distant f m fo dation---!-�__�-..Distance to nearest lot line__ _-_ Number of pits---! -- -_---- material_____ __ _�I Size: Diameter----.�,..3__.____Depth-._v�_�_________________ Cesspool: [Distance from nearest well-----------------Distance`from foundation--------------------Lining material-------------------------------------- F-1 _.________----__- _-__-__--._❑ Size: Diameter------------------------- ----------Depth-------------------_------------------------------Liquid Capacity----------------------------gals. Privy: _ ------------------------------------------ Distance from nearest well_ ___________________________________'_______:__Distance from nearest building ❑ Distance to nearest lot line`-----------=----------------_..... -------•--------------------------------------------------------------------------------------------- Remodelingand/or repairing Idescribe):-------------------------- --------------- ----•----•-----------------•-•-----------------------•-------------......-------------------------- ---------- ti-•--•------------------------------------ ------ ---------------------------------------------------- *----------------------------------------------------------------------------------------- I here y cert) y that I have prep r this a plication and that the work will be done in accordance with San Joaquin County ordinances, to e Its a Drules and `re latia of the $an J6 quin L a ealth District. i (Signed)----- ------ --•- ------• rul ----- -----1----------------- ----------------- --- ------ O ner and/or Contractor] a - �r'� = (Title) SY= ----------- ----• - ------ - ----•----------------------------------------- (Plot plan,' showing size of lot, location of system in relation to wells, bui j gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- ---------------------------------- DATE------------------- - --------------•-------------- REVIEWED BY--------------- ---------------------------- -- DATE---- � I�� 7------------------------------- ------ -- -------• ------------------------------------- r BUILDING PERMIT ISSUED f --------------------------------------------------- -- DATE------------------------------------------------------------- BUILDING and/or recommendation : ------------------------------------------------•-•------------------------------------------------------------------- --- . z "' ----- r fix_ a - - --- - ------- -------------- -- ----------------------------------------------------------------------------------------------- -- - ------------ . I --------------------------------- ------ - -------------------------------- FINAL INSPECTION BY:__)?" ° ------------- Date------ ------ -- - V-. /U 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 . CG—a_9AA • Ra,A—A W_91nn