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.APPLICATION FOR SANITATION PERMIT Permit No...v`l.-�'__�-�- n � (Complete in Duplicate) Date Issued�..?,/_�__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 Or inance 549. -- _ _ JOB ADDRESS AND LOCATION--------: 67-z17!_ -------------------------------------------------------- Owner's Name--------------------- _ -------- --------------------------------------`'Phone_):_XJ7'--�.--- ----------------- p- as� _ ----------------------------- Address---------------------------------------------= ' ---- - Contractor's Name------------------------- _ � GLI ` - - - - --!�------------------------------------------ Phone----�! `f---4°f-------- Installation will serve: ResidencApartment House ❑` Commercial ❑ Trailer Court C] Motel ❑ Other E]Number of living units: __21"Number of bedrooms _Y/_- Number of baths /____ Lot size -__ Q_ �____I_f__9_�------------------•-- Communit system Private Depth to Water Table_ ft. Water Supply: Pub4ic system y y ❑ ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Learn ❑ Clay Loam ❑ Clay ❑ Adobes' Hardpan ❑ Previous Application Made: Yes ❑ Noj'P�_ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Talk; Distance from nearest well_________________Distance from foundation--------------------Material---------______.________-_____________._____-_.-. No. of compartments------------------ Size--------------------------------Liquid depth------------------------.-Capacity----------- _ rr�� r-`—---- '� Disposal Fie Distance from nearest well ._____ _ __ ._Distance from foundation_�I�"d�.___._Distance to.nearest lot line., Q- - --------- Width of trench---al `s----------------- Number of lines__ ___________�_�P__ Length of each line- ` fE Type of filter material--1JJ_._____ �_____Depth of filter material-Ji_____-______._Total length___`---------------------------- Seepage ________ __________�_.___ Seepage Pit: Distance to nearest ell----fT.4'�+.)----Distance fro founcla+ion__—'/P.'c__.Distance fo nearest loi'-line__9�_-.-_.___ plumber of pits-------I-----------Lining material_�r __.Size: Diameter__.,�_d__�-_____.Depth_ i ' _Z-_ Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material__._-..-___-________________-._-_____. ❑ Size: Diameter--------------------------------------Depth-------------=--------------------------------.------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____..___________________--___________- ❑� -Distance-to nearest-lot`line _ = ----------------------- -- ------ - - - -----_-- - ------------ ---- ----- --- ------- -------- �Remodelingr_6land/or repairing Idescribel: ! ^°' -------•----------------------------------------------- + -----------------------------•---------- •-•------ 1 - - - - - -------------------------------- hereby certify tha I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan es, ate ws, an rules and regul Cthe San Jo quin Local Health District. (Signed rK.�'�1/ L,--' Q�7s� T ------- ---------------------------------- -.-----------------Owner an /or Contractor) +-... s/V ---------------(Title)---- "'_i M -P Z0 J--------- ------- By:-------- - ---- ----_ r - g p ) (Plot plan, sh ing size of lot, location system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ .---..-____ ___________ DATE__!__- ----------------------------------------------- E__._ _ REVIEWEDBY---------------------------------- --------------------------------------------------------------------- DATE __ BUILDING PERMIT ISSUED--------------------- ----•----------------------------------------- -----r----- --------- DATE -'jQSs -- Alterations a /or r mmendati s• . '�� :-: _ _ -- ----oma--c --------------------- --- - --- -- -- ---- ------------ -------'_ __________ t___-___.____!_____ ____________ -------_J__-_______�- -- ------ ---- ---•---------------- _________ __•_-' ----•------------' -------------------------------------------- -- -1______ __ - - . _ __-________________ _____________ __ ____ _______ --.--_____________ FINAL INSPECTION BY:-- -------------------------------------- Date-------�. ` + 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 Y ES-9-2M 8-51 Revised W-2100