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pe�mit APPLICATION FOR SANITATION PERMIT N�o. -_ ��-__-• { f�\h (Complete in Duplicate) y/ r Date Issued ------ -_1 ------ 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. n -- ---- .108 ADDRESS AND LOCATION---- -,�/�--�---fs-�-- - - ��--------------------•-------------------------------------------- ----------------- Owner's Name------------------------------------- --- ----- - - - - ----- ------------ ---------------------- Phone__ ed_X?-_. Address------------------------------------------------- --------------------------------- -------------------- -------------- Contractor's Name = e----- --------- Phone-- Phone--�� Q-7---------- Installation will serve: Residence #k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { . y r Number of living units: _�____ Number of bedrooms 3._ Number of baths _ __ Lot size ___ i ___ Q-Q---------------- Water Supply: Public system ❑ Community system ❑ Private ❑ DepthtoWater Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe& Hardpan ❑ Previous Application Made: Yes ❑ No tRJ2_j�ew Construction: Yes ❑ No ❑ �~/t, ,yA.- I &Sef INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permitted if public sewer is available within 200 feet.) 4: Distance from nearest well_________________Disfance�from foundation----':_:___---_____.Material________--------__________________________----- '7 No. of compartments--------------------------Size--------------------------------Liquid depth-.:--- --------=-----------Capacity----------------------- s c�r Distance from nearest well__________________Distan rom undation--------------------Distance to nearest lot line_________________ Number of lines--------------------------------_Len o ch li ----------------------------.Width of trench----------------------------------- Type of filter material---------------_---------De th of filte mat rial-_-____________„_____Tgtal length--------------------__________— _ v Seepage. Pit: Distance to nearesf ell-_� tan fou tion_ if -_ e ...Dis n �9 nearest of li e___e�•__ Number of pits- ____________ Lining mat ri ize: D"meter___--- -----.Depth--- - # s� 1 ❑ Size: Diameter--- •--: P .------------------ -------------------•--------Lining material------------------------------------- Diameter ----------------------------- l " De th__ liquid Capacity_-____----•----------------gals. Cesspool: Distance from nearest well_________________Dist nce from found Pion---- ----.-_____ Privy: Distance from nearest well____________________ __________-- istance from nearest building__________,_--________________________- 1 ❑ Distance to nearest lot line-----________________-- 1 ,.. Remodeling and/or repairing (describe):-------------------------------------------------------------_------------------------------------------------------------------------------------------ -------------------- 3. ---------------- --------------------•----------------------------------------7-- ----------------------------•-•-------------•-------------------------------------------------•------•----------------•--------------------------•----- r1� I hereby certify that I have prepared this application that the work will be done in accordance with San Joaquin County ordinances, St laws nd u es regulations of the n Joaquin Loca eel+h District. , , ,,------IF------/--)"W------ --- --- - reedon ) {Signed}_______ ________ _____ `-_•- G�Ic - Contractor BY' --- --- ---•- {Title)- "'�S-Q/os.�----------------- Plot plan, howl slze of lot, location of syste n relation to wells, buildings, etc., can be pleverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED SY----------------- __ _ ___ ---- - --- ------- -- •--------------------- DATE - ----------------------- REVIEWED BY - - -- --- -------------------------------------- ---• DAT _ -- BUILDING PERMIT ISSUED - --------- - -------- -------------------------- DATE } Alterations and/or recommendations--------- --------------------•----------------------------------------------------------------------------------------------------------------------------- ----------------------------------- --------------------•----•-----•--------------- i "- '------------------------ ------------------------------•--•----------------------------•---------- --------------------- } FINAL INSPECTION BY. Date_- -_ - - --------- ��' _ SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street r Lodi California Man+eca, California Tracy, California Stockton, California ES-9---2M 8-51 Revised W-2100 ,�