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f j APPLICATION FOR SANITATION PERMIT Permit No. _51 .7,_Z__5.__ (Complete in Duplicate) Date 'Issued -----!r- 5-d_-- Application 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, � E JOB ADDRESS AND L ATION______ -OJ--_ �r��! �� --------- ---------------------------------------------- ----------------------------- Owner's Name d . . ---76_0,t�Z_l ...... Prone Address AG /r�'-r✓-.1A--------------------------------------- Contractor's Name---------••----- - f ,ac -»- - Phone Installation will will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/__ Number of bedrooms _-/__ Number of baths -Z--- Lot size ----- ---•-------------- Water Supply: Publics stemTable4 �' pp y: y Community system ❑ Privafe ❑ Depth to Water ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ti Clay Loam [:] Clay ❑ Adobe 9 �ardpan ❑ Previous Application Made: Yes ❑ No V�r' New Construction: Yes ❑ No � FHA/VA: Yes ❑ No [ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j p#ic nk: Distance from nearest we]-----------------Distance from foundation-------------------Material------ No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity--•-------------------- ispo Field: Distance from nearest well....._""--------Distance from foundation_- ,347/__Distance to nearest lot line--A_L�w___!__ It Number of lines------- _________ of each line--- __ s1 I�� L /Length �-�------ *r Width of trench---a.�� ------------------- Type of filter material_,f .Depth of filter material-__._/�- -.-.--Total length____- --------------- •------- Seepage ----.. Ir See a e Pit: Distance to nearest well-- � -----------Distance fro fun ion___-_--- ' 0'` ��p g ��._-._..D-stance to nearest lot line-- -------------- Number of p:ts----f- -------Lining material__, "e: Diameter___1_f �_�'� i ----Depth Ale rr', Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---___-_.-___-.--------_-------____. 0\ E1Size: Diameter------------------------- --- -------Depth--------------------------------- -----------------Liquid Capacity----------------------------gals. `.. Privy: Distance from nearest well _--------------_---------------.-------------Distance from nearest building----___------____---._-•_ 1�V ❑ Distance to nearest lot line----------------------------------------------- _ (� ---------------•--- ----------------------------------------------------------------- Remodeling and repairing (describe)________________ -------•-- t'x= -- .�'-----•---------------------------------------------- --------------- •--•-------------------------------------------------------------------------------------------------------------------------•----------------- ---------------------------------•---------------------------- --------------------------------•-------------------------•--------------y-------------------- ------------- I hereby certify that P have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. (Signed) r`-------- ---- ---- ---/�--��r -= - - -- --------------(Qwner.an �"o?Contractor) `1 By:---------------------------------------------- ---- ------ :f'" '. •= - -----------------------------------(Title)--� ` r' (Plot plan, showing size of lot, Iota of system in relation to wells, buildings, etc., can be placed on reverse sibs). FOR DEPARTMENT USE ONLY APPLICATIOWACCEPTED BY-�� ----- --- ----------------------- ---------------••---------------------- DATE-U------------------------------------- REVIEWED BY - --------------- DATE-----tr----------------------I IN PERMITISSUED----------- -- -------------------------------------•-------------------------------- DATE---------- Alterations and/or recommendations-------------- ---------------------------- - - ----------- ,Ir- :.....�en7....... 1'�'� �l 4--"----- 7'�.0.---R?n4,14-Q----�f2.7-'-----•--- � 7�� j *;-------�5 .' � ane-----z?z----'�� ar------1. ------ ------------ f (} yam / _.y� ,.- G *i Y4l�` - -- '---- lafr r*vti '-�' Y3/� . ......... -'` = :'_ff� lrt.U-•------- l� Al !_ 1��-z�LG_ :1 P` FINAL INSPECTION BY-------- ----------------------------------- ---•---------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT f 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 , Revisea' 1.57 F.P.CO. ' ,.s