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Com'" APPLICATION FOR SANITATION PERMIT Permit No. .......... (Complete in Duplicate)p ate) Date Issued _14.___1-------`� 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 O ATION. .. x /j �.--`--------� /--G 1G�-tr �. ,,.------------------------ r Owner's Name r� '- -------------------- ----------------------------------- 1�-.�- -.= ---..� _Q►--4 .. Phone Address-----------------------•-.. f - ------------ '.... ..a, =t-''y------------ ----.�---d'�- f# Contractor's Name_ c-i. �'f �"� --`-`�r:--- --r - Phone Installation will serve: Residence ❑ Apartment Commercial ❑ Trailer Court E] Motel E] Other ❑ -_ �. Number of living units: _. _ Number of bedrooms Number of baths Lot size -----_--.___ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table 14 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[T/Hardpan ❑_. Previous Application Made: Yes� ❑ New Construction: Yes ❑ No ❑ ) 4 TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T$,nk:— ' Distance from nearest well----------------Distance from foundation--------------------Material__----------.-----._----..---__----------._.-._-. .v- No. of compartments---------- ---------------Size---------------•---------------Liquid depth----------- --------------Capacity----------------------- Osal ilield.- Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line........... --'j_ Number of lines-----------------------------------Length of each 1ine------------- - -- -------- -Width of trench----------------------------------- Type of filter material_________ _________Dept o i t material----._-----------------Total length------------------------------------------ See age it: Distance to nearesj well__ .il ....Di In �ro fpion--�S�.._'____.D'' t ce to nearest lot line___ __._Number of pits----------------------Lining ma-erial_-_- .�----- ---- Siz : Diameter_-- .�.....Depth-__ _r�-_-_____ ------ 0! ---- V, Cesspool: Distance from nearest well------------- istance from oun ion....................Lining material_.___.___.____.___._____._.__._____ ❑ Size: Diameter----- --------- ----------------De ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------.------.------------------------Distance from nearest building.____---____-.--_--__-___-----._---_-_-_. 1 ❑ Distance to nearest lot line--------------------------------------------------------------------------------------- -•--------------------------------------------------- Remodelingand/or repairing (describe):------------------------- -------------------------------------------•-----------------------------------------_------------------...._-............. v ----------------------------------------------•-----------------------------------------------------------------------------------------------------•---------------------------------------------------- n ------ I hereby certify that I have prepared this application and that the work will be done in accorda ce with San Joaquin County ordinances, State laws, and rules and regulations of the San oaquin Local Health District. DAY a NIGHT (Signed)- i� � Aeztec_ rr se ----- -- ----- --------------- - - - wbet Contract ) :°arr^g06 SaEldorardoB I'io Z•7l--�- - / ---------Vetc., ------ I 1 .' --. �' --(Tit e]. (plot plan, showing size of lot, location'o�system in rel i to wells, buildin can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY.'�',_jh,----- ------ - ------ ------------------------------------------------------------------- DATE;=--------------- ------------------------------- IV -- �``'� - - . .�- ---------------------------- BUILID NG PERMIT ISSUED............W DATES- ------ -------------------- --------------- Alterations and/or recommendat ns------------------- --------------------- ---------------------------------------------------- �_.s-1 - - -••J��f- -�. .--- ------ -. - - --- _._ __ _. ._ -- ------- ---------- --- ---------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- -----------------------------------------------------------------------------.-------------------.-----------------.-------------.---------------.-----...-------------------------------------------------------------------- ----------------------------------------------.------------------------------.._.._---__--...._-------..---------.------..._.._------'--_._-------------.--...-_-.--------...--------.-•__-----•`--------------------- FINAL INSPECTION BY: ( -------- ----------------------------- Date. AN 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 145446 ATWOOO