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�.- I APPLICATION FOR SANITATION PERMIT Permit No. -- � �l (Complete in Duplicate) Date issued __r_ /. l� IMS .c Applica*ion 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 o. 549. G ! r /`�."X/✓�O.��JQ-✓, �� i---- / ---------------------- -- _ JOB ADDRESS D LOCATION------ -- --------------n.--- ----- ------------ � 7 P Owner's Name: _. hone ---• -- ---- aai� r, y Address... ' ; --a------------ ---------------� -------------------------------- ---------------------------------•---------------------------- -•e --...------•--------------------------- ------•---- .----. Phone----..--.....-------•-------------- Contractor s Name..- -...c!P � ------. ------------------------------- Installation will;lserve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i;of living units: _-;_--- Number of bedrooms __ Number baths -_----- Lot size ..-/-095;0--- - ------------------------ N '_ '- Water Supply:' Public system ❑ Community system ❑ Private Depth to Water Table ._...--_ ft, Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam ♦ Clay Loam ❑ Clay [I Adobe [B Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes Mf No ❑ ar TYPE OF INSTALLATION AND SPECIFICATIONS: ( ptic tank or cesspool permitted if pu !ic sewer'is available within 200 feet} No se e 'I ista cel fro- fou tion__ ____________Mate ial.- -- ---- ----------------_ Septic ank: Distance from nearest wel --- 3Jo. of compartments -- .-.-.Sile- .- '4--�.-----, Liquid depth, +'f' Capacity �� j ' [� 7tt�mt/r is+ansa from foundation-._ -. - -- _-. _!Distance fio nearest lot�11,1e,Disposal ) laid: Distance from nearest wel D -.-- f ( Number of lines------------- • _-- g J 0- �'en th of each line-- -__- ,�idth of trench.----_Z --.- Type of filter material' 9 t fh of filter material--...__ _ ._-_--Total kength--_--.------ -_ -__-----_.---- - --. ------_--..Distance to nearest lot line_________________ Seepage Pit: � Distance to nearest well----------------------Distance from foundation---___._ r, ❑ I Number of pits----------------------Lining mate,rial-----------------------Size: Diameter-----------------_----Depth--------- ----------------------- (3 q Cesspool: Distance from nearest well-----------------Distance from foundation.-.---------.------ Lining material---.-.-------_--..-.._---------_---. ❑ ? Size. Diameter------------- ------------------------Depth-------------- ------ -------_---------------------Liqui.d Capacity-- -------gals. Privy: I Distance from nearest well-------------------------------------------------Distance from neares+ build ing--.-----_-.--.--_:.--------___-----------. Distanceto nearest lot line--------- -------------------------------- ------------ ------------------------------------------------------------ r------ Remodeling and/or repairing (describe):-------------------- --- - --------------...-----------------------------------------------------------------••---- II ---- ------•-- -----------------•------------------------------------•-------- -------------------------- ---------- --- -------------------•• *-------•---------- - certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulafidns of the San Joaquin Local Health District. A�a 1 � �A Z� -------------- ---- ---------------------------- ----------------------- _ Owner and/or Contractor) -------------------------------------- Tale (Plot plan, showing size of lotjocation of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. -_- DATO��--------------------------------------------------- REVIEWED BY--------------------------- DATE-- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------- DATE Alterations and/or recommendations:.------------- ---------•---------- -------------------.-----------•------------------- i; --------------------------•-------.. I'. ----•----------•----------------••--•--------------------------------•------ -------------------- i---------------------------------------------------- - -------------- l -- ------------------------------------•--------------------•---------•--------- ---- 16 FINALINSPECTION BY:.. ------- _ /A------- ------------- Date------------------- -------------------- ------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 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 1459 ATW...