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` l 41 APPLICATION FOR SANITATION PERMIT Permit No. r (Complete in Duplicate) e _ lO Date Issued _J.g'R Applicaliom is hereby made to the San Joaquin Local Health District for a permit to construcf and install the work herein described. w This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATIO r J7` --------------- ---- --------%/-----------------:_J-.-- � Owner's Name------- - a Ph p� ----------------------------- ' - ----------= one__---------------- Address------------- •---�+k.__.------ - . . ----�-�--- ------------ --------- -----------------------•---------••-------•--------- ------- Contractor's Name_..____,. _ °-- ---t�' _ __ �r ------ Phon _f�___jW0.7_- Ins}alta}ion will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel [] Other E]Number of living units: __/---- -Number of bedrooms __ li. Number of baths ___/__ Lo+'size f�a = -----------------------F Water Supply: Public system E] Community system E] Private e th to Water Table Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam Previous Application Made: Yes No I ❑ .,clay ❑ Adobe ❑ Hardpan ❑ ❑ New Consfruction• Yes`❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` 1 (No se i pt c tank or cesspool permitted if public sewer is available within 200 feet.) epfi Tank: Distance from nearest well------------------Distance from foundation___________________Material__-________--_.__ _'____-:__•---_-_-_ e 01111 No'. of compartments--------------------------Size--------------------------------Liquid depth_ = =Capacity Disposal Field: Distance fromnearest we ____-_ .�_--. -_ . Distance from foundation______ __ r ,/(�_.__-_:.Distance to nearest lot line--�+�-•_- I Number of lines________--__�� _ Length of each fine___ _- J �.t? - = Width of trench--o2-- Type of filter rriateriall��_ ---Depth of filter maferial___- --_ _-Total length_____�_ �---I ------------ ___ Seepage Pit: Distance to nearest:we!!_--_ "--_._------stance from foundation__.:._: `_ ..,Distance to nearesf"lot-line__-`-_--_--,---- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- i ---- ---Depth Distance from nearest well-----------------Distance from foundation.__._______ -___;Lining material-------- El Size: Diameter - --- ------Depth----------------------------- - _ ----- --- - Liquid Capacity_.-.'---------- -- ---gals. Privy: Distance from nearest,well-----------_____s---------_ -Distance from nearest buildingEl Distance to nearest;lot,line +^- - -- w. Remodeling and/or repairing (describe):__-___-77�___ __---.- ------------- ••----•------- ----------------------- e -- ---------------------•----------------{-------'----------•-------•----`------- �------..-..------------------ 1'-_-----11. --------------'-•-------...---------------------------_-----------'- I'hereb certify that l have Y y prepared this application and }hat the work will be dene in accordance with San Joaquin County ordinances, State IIs, and rules,and regulations of the San Joaquin Local Health District. (Signed)---------- -- 1 E C� � rand/or Contract ) nd/o or ( ) - --- ----- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------- ------- J DATE REVIEWED BY------------ `' �- ----- DATE. --------------------------------- BUILDING PERMIT ISSUED --- ---------------------------------- --• DATE - A terations aid or r endaf'ons:�5 /f`S ti -- --------- -- •-- ..._'--!'�°_: --- -------------------- I --------------------- ---------- ----•--------------- ------ ---------- n --------------- FINAL INSPECTION .BY: ---:T_•------------- "` ► Date_ - • SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Y Stockton, California Lodi, California Manteca, California 814 North "C" Street Tracy, California ES-9-2M ; Revised W-2100