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tACI APPLICATION FOR SANITATION PERMIT Permit No. �� (Complete in Duplicate) y� (� �o..,... _ } -t r _ - _. Date Issued_.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins+all the work herein described. This application is made in compliance with County Ordinance No: 549. JOB ADDRESS A LOCATION �_�.J1-C�Z51i7 e ::# J_ •... ------------- �r Owner's Name--- Phone Address------------------ - - ----- ------ < Name-- _- ---------- Contractor's` F -----�-- tg �------------ -��- - ----- �'-L-�-------- Phone i Installation will serve: Residence A artment I louse r i j p { ❑ Commercial ❑ Trailer Court ❑ Motel! ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _---____ Number of •tis ___-___ Lot size ------ __ 1 - r WaterSupply: Public' system ❑ Communitytsystem El' Private - Depth to'Water Table •::___-- ft. ` Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan 0 i Previous Application Made: Yes ❑ No ❑ ' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALL- T40N AND SPECIFICATIONS: - t (No is tank or'cesspool permi+ted,if public sewer is available within 200 feet.) I 1 e is Distance from nearest,well--------------- =Distance from foundation_-_______ �F erial ____.Mat ....... .------------ _ ---------------------------• -- No. of compartments- -------------�_�_,----Size----------------:--_F_--- -._ _Li Liquid de t 1 }q P Capacity----------------------- osal Distance from nearest well- .Distance from foundation --,-,/ ____-__Distance to nearest lot line_-_ _ umber of lines --- ��___-- _-1#-- . _- -.Length of eacWlinef- - -�------------Width of trench..' I ---------------------- Type or filter materiel-Depth,of filter material_`_.�/ " Total length_:_ _ �-r__-_•_---_-----_______-- 1 �� (. ag 1t= Di*. r ste f of nearest Distance well- /-�p-_d_-'_Distance rom foundation__ __- � _ f ---_--- ce tonnearest 16f'line _-l__y _•. pits------ ---------- -- Lining matei•ial___p�_ -oci Size: Diameter__-_ ��----.Dept h --- Z�--- --_-_--- - --- i I Cesspool: ,Distance Die from nearest well -------- - ---- Distance- fromTunclation-:_' ____-_-'_------ Linin material __---_-_-----___-----_-__-____------ ❑ Size: Diamete•r-------------- ---- --------- Dept h-'4 ------------------------------------------------- Liquid Capacity----------------------------- gals. a ,.. Privy: I n Distance fro __-_ m nearest well_________________ _ ----Distance from nearest building ❑ stance to nearest lot -line -r ----:-------------------------- Di - ------------ t Remodeling and/or-repei desc �beJ: '. } r I x- ---- -------------- -----------------•----------•-- ---- GE,z°'11 --•----------- ----- ---- 1 --------------------------------- =---- ` I hereby r i y, that I have prepared his -a plication and that.the,work will b done in accordance with San Joaquin County ordinan St aw d rules and regulations of the San Jo quip oval Health Di t. e i (Signed)-•-- f - --- -- I ----------- . I r Contractor] By---------•---•------------------------------- :------------------------------------_ s P of plan, showing size of lot, location'of system in rola ' o Is, buildings, c. an be placed on reverse side). E , DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY _____ _--_-----___-- -- f/ ---------------•------- -- J _ REVIEWEDBY---------* ---- DATE f ----------- BUILDING PERMIT ISSUED ------ �----------------- �-------------------- �--------- -------I---•---------•------------ Alterationsand/or recommends+ions:------------------------------ t-----------------------------=-------------------------------------------------------------••----•-•----•-------------- f6 ------------ ---------------------------------------------------- --------p: --. I -- rTilt -i Y-- ----------------- ----------- E --------------------------------- --------------- ---- - FINAL INSPECTIO ------ Date=------ 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 Rovisea 1.57 EP.CO.