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if APPLICATION FOR SANITATION PERMIT Permit No. ... _-.- ... F1� (Complete in Duplicate) � 'Data Issued :__-.0 -_---3.:��3 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. JOB ADDRESS AND LOCATION-------- - ----N .. Owner's Name-------------------------------•------- 4LA------ FAZIAI-14-------- - - ---------------------------- ----------- Phonea -- %f- Address-----•-•-----------------------•------------------AL7,32---- ---- -------------------------------•-------------------------- --_------------------------------- 4 �' --------------- Phone-_-9.Contractors Name--------•------------------------------ �-Irk 1?..\-�i�.-------�`.1'>LC....r.-• ------------•-------- - � rit �?-±a-�-'--------- Installation will serve: Residence 1�. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.1—Number of bedrooms .-- Number of baths ---11---l-of size _—----- --"---------- Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATIONS/AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) tiZT I�: i Distance from nearest well__--------------Distance from foundation--------------------Ma#erial------------------------------------------------- R.jM-f'u• No. of compartments-- --------------- ----Size-------_------------•----------Liquid depth---------- - -------- Capacity----------------------- Dispossail to nearest lot line----------------- Length ---- -�---- f` D+spos I Field: Distance from nearestt well-- _>F?-------Distance from foundation--- V1 Number lines----_-.[- --.-- Length of each.line----- C�.f_----------- Width of trench---R—9c----------------- -------------------- it ---------------- t tt t Distance to r materlal.__1_ f�k Det +al Total length--4-0- Number Type of filte ( --------- Seepage Pit: Number of 'nearest ell-._j��'+n -----Di and erom fo dation-1_A- -_--.Distance to nearest lot line___-_-- �A I p• l g o iV,__ iameter 7�y�.. Depth-- f �f4 �_ A.6 Cesspool: Distance from nearest well----------------- n�from ou --------------_.Lining-material-----:-------------______---__-- Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity--------------------------gal4 ❑ .l Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- ---------. ❑ Distance to nearest lot line-- --------------------- --------------------------------------------- ---------------------------------------------------------------- }1 Remodeling and/or repairing (describe)-------------------------------- ! •----------•-----------------••-•-•------------------------••-•----------.-------------------••------------------------------•-------------. - ---------------------------------- ------------------•--------------------- --- ----- ------------------------------------•-----------------•----•-------------------------------------------------•------------------------------------ ---- ----------------------------- -- _------------------------------•----------------__----- '----------------------------------•------------------------------------------------------------------------------------------------------------------------ --".-."-.. ! hereby c i that I ha a prepared this application and that thew rk will be done in accordance with San Joaquin County ordinances, Sta e I s, and r es and gulations of th an Joaquin Lor. I Health District. 0 (Signed}. �r + --------------- ----- ( � wContractor) SY - - --- -- ----------------(Titlel } P (Plot plan, showing size of lot, location of system in re tion to wells, buildin , etc., can be placed on reverse side). :.� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ----------- -------------------- / DATE- �' �`` REVIEWEDBY------------------------------I-------------- ------------------------------- ----- ---------------- DATE--------------_--------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------ ------------------------------------------------------ Alterationsand/or recommendations:------------------------------ --- ------------------------------------------------------------------•-------------------------------------------------------- I --------------------------•--------•----------------•-------------------------------------------------------------------••--------------------------------------------------------------------------------------------------- l I ---------- --------------------------------------- ---------------------------------- f I I ^� FINAL INSPECTION BY:------- = '------ ------ --- �. Date-------- E ----------- 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 10-52 Revised W-2100