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APPLICATION FOR SANITATION PERMIT Permit No. R.�?...... (Complete in Duplicate) Date Issued A e T�plica+ion is hereby made to the-,San Joaquin Local Health District for a permit to construct and install the work herein described. Coity Ordinance No. 549. application is made in compliance with oyl (7ey I /I -/ -V-A- L111V JOB ADDRESS ANOL CATION,----6;� . ....... -- -------- a-r. Ax, ----------------- --- - RkvneR ii Owner's Name---------Lei!� - - - ------- ---------------------- ------ -tl......... .....LPhone-------- ----------- ---------------------- A---------- - - ------------ Address----------- ......6 --------- - ---------- .... - -- ----- --- Contractor's Name--------------- .. - ------------- - ------- -------------- --------------------- ----- --------------------- ---- ---------- ---- Phone/JV711��,�� Installation will serve: Residence E] Apartment House ❑ Commercial Trailer Court 0 Motel 0 Other El Number of living units: of bedrooms Number of baths =-- Lot size ---6-------e ___________ ------------- Water'Supply: Pu'blic"System F-1 Commuriify system-=-Priv-afe � Depth to Water Table 4wft. Character of soil to a depth of 3 feet: Sand El Gra\vel El Sandy Loam Ej Clay Loam 0 Clay El Adobe ' Hardpan C] Previous Application Made:, Yes 0 No X- New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS:',_." (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------3Distance from foundation--------------------Material---------------- --------------------------- ❑ Atc?, ejCIS-11 No. of compartments- - - - ------------------Size-----•-•----------------------- Liquid depth------------ -------Capacity------------- -------- Disposal Field- Distance from nearest well-----------------Dislance from foundation--------------------Distan ce.to nearest lot line.-_-___.______.__ ❑ -xfS ine----------------- yA16 Number of lines-----------------------------------Length of each line----------------------- -Width of'french----------------------------------- Type of filter mafer;al------- -----------------Depth of filter maferial------------------f....Total length_-__--_.__._________.______--_.___..____ rorrL fogridation- -&96------..Distance to nearest lot-line Seepage Pit: Distance to nearest well-400- -._______Distance A I- 'line___—---- pth -------------- �.Size: Diameter Depth D, Number of pits...07.)el _Lining maferial--0� -A I i----t Cesspool: Distance frorn nearest wc�ll-----------;......Distance from foundation._----------------Lining material-------------------------------------- Size: Diameter. -------- ........Dep ------Liquid Capacity----------------------------gals. 11 fh------------------------------ --------------7� Privy: Distance from nearest well-- ---------- ------- --------------------bisfanco from.nearg-5+'6uiIclib-g------------- ----------------- ------- ❑ Distance to nearest lot lire--------- -- -------------- -- ---------------------------------------------------------------------------------------- ------------------- Remodeling and/or repairing (describe):...... -- ---- ------- --------- ------- -------------11--------------------------------------------------------- -------- -e----------- ----------------------------------- ------------------------------------------------------------- -------------------------------------- --------------------------------------------------------------- ----------------- L ----------------------el--------------------------------------------------------------------------------------------------------------------- W,-;L . l I hereby certify t ha bip-repared this pplicationand-that the'-work will be done in accordance with San Joaquin County ordinances, State law and r es and'-regulaf ns of the San Joaquin Local Health District. 7 --- wrier andr/q�/Contractorl ---------- ........ (Signed)--.-••--------------- --- ------- - ------------ --------------------------- rs By:------------------- ------- - -- ------ ----- -- ----- (Plot plan, showingsize of lot, oca ion of system in relation to IIs, buildings, etc., can b n reverse side). FOR DEPARTMENT USE ONLY -------------------- DATE----- APPLICATIONACCEPTED BY- ---------------- ---- ---------------------------------- -10--------------------------------------------- -- REVIEWED BY-------------------------------<-------- --------- ---------------------------------------------- DATE.,------ - - -- -------------------------------------------- BUILDING PERMIT ISSUED--------------------------- --------------------------------------------------- --*---- DATE-----.- --------------------------------- Alterations -----------------------7-------- Alterations and/or recommendations_________________________ ----------------- -- - ------- -- - ------------- ----------------- ------ ---------------------------- ---------- - ---------------- - --- ------/�------------ ------------ -------------------------I----------------------------- ------------------------------------ --- � ------------------------- ---- -------------------------------------------- ----- ------------------------------------------------------- ------------------------ -----------I------- ------J-7--- ---------------------- --------------------------------------------- --------------- --------------------------------------------------- ------------------------------------ -------------------------------- --------------------------------- --------------------- ------------------------------------ -------- ---------------- ----------- ...... --------------------------- ------------------------- ------------------- --------- ------ ----------- -------- FINAL INSPECTION BY:--- ------------ ------------------------- ------- Date...------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWnDD 12-54