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s I , F. APPLICATION FOR SANITATION PERMIT Perris it No.4.4--- -_ (Complete in Duplicate) Date Issued ----------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application N made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_----- T -Z__w___I Owner's,Name------- ----------------•----------- ' - i--{ � �-------- - �1yQ---- ---------------------------------------- Phone-- ��:-•- �?-�,.-+� Address-----------------••---------- k, 't UIJ ----------------------------------------------•--------------- Contractor's Name---------------------- r �.5° L_�_l1_-" a�l.��-- '.....---------------------- Phone f�"�� O� ------- -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [I Other El Number of living units: _1< Number of bedrooms J'__ Number of baths -_- Lot size Water Supply: Public system ❑ Community system fl Private A Depth to Water Table 4/0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan•❑ Previous Application Made: Yes ❑ No.1�4_ New Construction: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ep Distance from nearest well-----------------Distance from foundation____-----__ -----.Material � No. of compartments--------------------------Size Liquid depth Li e Capacity q p --------------------- field: Distance from nearest wEli_________________Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench----_--------------------------__-- Type of filter material_._---- --__-_Depth of filter material----------------------- -- - Total length----------------------------------•------ JF .� Seepage Pif-s' Distance to nearest well,f__m/) Distan f fou ation___l�__----_-.D• tante to nearest lot line-__� Number of ---------- Lining materialM - A,r,_' .Size: Diameter_y�,2-"----Deptht�_�'_'-_-_--___---____ ool Distance from nearest well _Distance from foundation--------------------Lining material--___--- _-__---___ Size: Diameter- ----------Depth----------------------------------------------------Liquid Capacity--------------------- --- gals. �f Privy: Distance from nearest well _----------------------___.-------------------Distance from nearest building ❑ Distance to nearest lot line Remodelin ---a----n----d--- /- nd/or repairing (describe)------------ _ _ = ------------------ - --------------------------- -------------------- --•-- . �--r� �� ----------- _i ' 1 S��---1 © �'-� C-- f ------------`-------------------------------- -- --------------- I hereby certify that I have prepared ;hisapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd nd regulations of the aquin Local Health District. k (Signed)------ ;B ---- = i B :.- ,,t - L ----------------------- ------- l ( a 1 (Tit e) - -1�-T_.ts'-Aw - (Plot p n, s size of lot, location of sy e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--C - ------------------------------------------- DATE__'_!�� REVIEWED BY------------ DATE -y--------------------------- ----------------- BUILDING PERMIT ISSUED ---------------- ------ DATE----------------------------------------------------- -- -------------- A terations and/or recommendations----------------------------- ----------------------------------------------------------------------------- � . ---------- ---------------- -------------------- FINAL INSPECTION BY:---, [}ate z-------�`S":SY " 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 8-51 Revised W-2100