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FOR OFFICE USE: ---------------- `-- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No, ...... ------------------------ ----�0a'- ------- (Complete in Duplicate) ------------------------------------------- This Permit Expires 1 Year From Date IssuedMEMDate issued .....................:./ ,. Application is hereby made to the San Joaquin Local Health District for 1&-3 ^060 07 q permit +o construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS �D LO ATI N__ _` 41YC _ $ •----•------------------- -..,g W. .... _ Owner's Name----- Phone - Address.1 . ._- - -- ----- --- -. Ru Contractor's Name------------- ...__.... I`"T �`� f ------ Phorig', "Installation will serve: ResidencgApartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherjEr L: -s t I Number of-living.units:.______.` Number of bedrooms -__-____ Number of baths ____.-__ Lot size ----------- Wafer,-Supply:, Publics stem , y. ❑ •Community system ❑ FrivatDepth to Water Table _ ft. Character of soil_to a depth of 3 feet: Sand ❑ Gravel ❑ ;Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ `Previous Application Made: (If yes;date___,, _____ --------) No ❑ New Construction: Yes ❑ No ❑, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No,septic tank or cesspool permitted if public sewer is available within 200 feet.)". tic Distance from nearest well_...............Distance from foundation_:._j----..---__---.Material .-_--.--_--__..------_------------------ .__.___. No. of compartments=------{'-- ------Size-----------•--------------------Liquid•`depth--------------------------Capacity--•-------------------- /Q r �- 101 Di pos Id: w Distance from nearest well-940_.___-_'Distance from foundation________ _ ____Distance to nearest Eofi Gne_____..��__ (2 ` Number of lines---.----/--------------- --- ----Length of each Iine.0 h i 6� Width of trench S ---------••- ., o,L �� Type of filter material � ' Depth of filter material----kl--.--____-Total length-------------- _. e it: Distance to nearest well_I Od)---_----_Distance from foundation__-- _�_-_...Distance to nearest lot line__. ...- � oel /� / r +�. Number of pits-----i---------------Lining material---��------- Size: Diame+er._cc _..____.--Depth____.o�S--_---- Cesspool: Distance from nearest well____--__---_---_.Distance from foundation--------------------Lining material_-_---_-.__.-_.------- -_ ❑ Size: Diameter----------------------------------=---Depth------------------•----'-----------------=-------.-Liquid Capacity-----------.. --------------gals. Privy: Distance from nearest well----------_--------------------------------------Dis+ance'from nearest building_ -------------------- _.___---- t ❑'i Distance to nearest lot line- – Remodeling and/or repairing (describe:______. { -----------------------------------•-----------•-------------i•----- - r- + _ -- -- -----------------•------------------' -------- ------.--••-------- ------------------------------------------------------- --------------------------------------------_----•-----...-----------------------------------•------•-----------•--•-------•--------- -----------------------------------------------------•----•--I--------------------------------------------------------------------•--------•-------------------------- -•-----------•---•----------•------------------------ 1 hereby, certify that I have prepared this'application and'+hat the work will be done in accordance with San Joaquin County ordina a to la Znd rules and regulations of the San Joaquin Local Health District. [Signed)_ - W Contractor) f ►� �, r BY y------•--------------------------; ------------- -- --------(Title)---•----------------------------------- ----------------------- (Plot plan, showing size of lot, location of system in relation to we, , buildings, a ., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---C- --:-7�— ---1:; REVIEWEDBY----------------------------------- ----------------------------------------------•--------------------------•------------- DATE --BUILDING PERMIT ISSUED-------------- ---------'�---------------------------------------------------------------------------- DATE Alterations and/or recommendations:----------------------------- q- = : -- ---'F---------- ------ `'t ��---- d_ ::_.._alt ....Is-t__[.K yc�`�s�SA_.. ------------------------------------------------- FINAL INSPECTION -BY:---- - ISS r Date----z----------------------I.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 R[VISM 0.59 F.F.00.1M 6-60