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APPLICATION FOR SANITATION PERMIT Permit No. ly (Complete in Duplicate) Date Issued -I A _15�---k__3 This is hereby made to the Son Joaquin�ocal Health District for a permit to construct and install the work herein described. is application is made in plia if n r nance No. 549. n e 0 JOB ADDRESS /N L C TI 0 .. .......... ---W------- fW Owner's Name----- --------------- :70 Address---_---------_ a,r ......$7 ----------------------------------------- Phone,Ft�.5-Ka/----- -----------W'w --------- -------- ----------------Z ---------- -------- --------------------------------------- -------- Contractor's Name Installation will serve: Residence -------------------------------------------- Phone_-,F7��a7---- V Apartment House El L r- Commercial E] Trailer Court E] Motel E] Other El Number of living units: ------ Number of bedrooms %5-- Number of baths/`400 Lot size -_ /"-0 Wafer Supply; Public system E] Community system Ej ---�(_ _r--------------x Z_S27--------------------- Character of soil to a depth of 3 feet: Sand El Gravel Ej Priva Private X Depth to Water Table ft. ' Sandy Loam E] Clay Loam E] Clay [_1 Adobe KHardpan [] Previous Application Made: Yes 0 No K New Construction TYPE OF INSTALLATION AND SPECIFICATIONS: : Yes X No E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --- --- ---- Septic Tank: Distance from neares+ well---7,.f......Distant from founclation-/0........... No. of compartments---- j_ Siz�Z_ Material---- ---- ------------ K .............. _X.Akiquicl dep.fh�_`_'_1.--------Cdpacify_./_;2_00__G_?9/, Disposal Field: Distance from nearest well__ -___-Distance from foundafion-_�Z,0----------Distance to nearest ]of 19 Number of lines______ - 11-------------Length of each line---laa_ Width of french,,.:;-1 I --------------- -4 Type of filter material0_1---WaVK,-Depth of filter material----IA9..........Total length___..Z6 --'w------------------ 0------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot 0 Number of pits----------------------Lining material...... ..... e: Diameter-------------- --------Dept h Distwell________________ --- --------------------- ...... & Cesspool: . ...........----Size: Distance from nearest well-----------------Distance from foundation---------r----------Lining material------------------------------------- Size. Diameter--------------------------------------Depth--------------------------------- ------------ ----Liquid Capacity----------------------------gals. Privy: Disfance f -- rom nearest well-__._____---._____- Distance from nearest building.---------__--------------------------- Distance to nearest lot line Remodeling and/or g---a--n--d--/--o---r---repairing 3114:31=�(describe]:_--- ---- -- -----------J------- -----------,------------------------- ----------------------------------------------- I----------------------- ---6_�------ --------- ------------------------------------------------------------ - - ----- -- ---------- ----------------------------------------------------------------------r--- --------------------------------------------------------------------------I--------------------------------------------------------------------*----------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfaf aws nd rules and regulations of the San Joaquin Local Health District. /Ws (Signed)----- ----------- -- --- ---- 44�1------- ---(Title]----- --------- ize (Plot plan, showing size ---- -- -------- - -------------- ------------------------ (Owner pnV6r Can-�-2- ------ ----- ractorj BY=----------------------- system in relation__ _4o`_j.4s, buildings, etc., can be place Pon'reverse side). of lot,�1,,a�lon FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY7�-------------------------------------------------__---------------------------------------- DAT&-_�, REVIEWEDBY--------------------------------5; 1- -- ---------------------------------------------------------------------------------- DATE--.;: -------------------------------------7-------------- BUILDING PERMIT ISSUED-------------� N -t-- --------------------------------------- 7----------------------------------------------------- s_e--------------------------------------------------------------------------- -to-------------I----------------------------------- Alterations and/or recommendations: -------- DATE.. .4A - ----------- -------------------------------------------------I---------------------------------------------------------------------- ------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------ ---------- --------------------------------------------------I------------------------------- ---------------------------------------------------------------------------------------------------------I---------- ---------- ----------11---------- -------------------------- ---------------------------------------------------------------I---------------------------------------------------------------------------------------- ------------------ - ------------------------------------------------ FINAL INSPECTION BY:____- Date'' ----------Z------/--------------------------------------------------------------------------- ----- _ex,<-- ----- --------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-7-2M 10-52 Revised W-2100