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'0* APPLICATION FOR SANITATION PERMIT Permit No. _4 - Complete in Duplicate) Date Issued A to construct anal install the Work herein described. This is hereby made-to the San Joaquin Local Health District for a permit co r 's application is made in compliance'with County Ordinance No. 549. JOB ADDRESS AND _/Z------------------------- OCATION----- -------------------- ------------------ --- --- --------------------------------- ----------- Phone--- Owner's Name- ------------ ------ -------------------------------------------------------------1-1----------------- ----------------- Address......��7 Contractor's Name----- ---------------- PhoneA/:7�a 4,r;� 7 44 ---- -------------------------- ------------------------V. .. ------------------ Installation will serve: Residence Apartment House Commercial E] .Trailer-Court [-] Motel E] Other ❑ : it'size Number of living units" Number of"bedrooms Number of . Lo --- __� ---------------------- Supply:' 'Public system J?__C'Omn�unify'syst6m ❑ Rri4t.e' 1-1 .Depth to"'Wat6r-T61ole _1514 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel- ] Sandy Loam El Clay liio, arn El Clay [] Adobe �arclpan D Previous Application Made: Yes El No New Const'rucffon-: Yes �o El TYPE OF INSTALLATION AND SPECIFICATIONS: j _ (No septic tank;or cess r;nifi�d if public sewer,is-available within e 'rithin 200 feet.) Ta k: Di�tance from nearest well_________________A��Distance from foundation--./.4�_ --------Ma� Se fi T ------- erial--------------------------------------------- I.........;7--------------- ep� e r,I�._of,comparfmenfis -d� h----- - --------Capacity- ---------- ----- Dis Distance from nearest Di5 I F.' Id: resf! ,fance from ft-vinclatio'n---/-� ......Distance to nearest lot]ine----------- p Number' of iines____' 4ti,n96 of each' 1ine___". 747"--'1 �____.Wiclth of trench.__....-'7 _--'Depth of filter material_-__-4? Total length-----------7 7 --- ---- ---- Type of filter ma��rjal d -------- Seepau.-Kit: Distance to qe-;r6st wpll.0�2 D ante fion '-A --------------=LL . ce to nearest lot line--- -------- A/ b P!r Number of pits------A(----------Lining m Diarne=er____ _4----------Depth----- ----------------------- a Cess'po6l: Distance frorn nearest well------—-------- Difa m onda 'on -------.Lining material---------- ---------- El Size: Diameter------------ ----------------------�Depth----------------------------------- -------Liquid Capacity----------------------------gals. Privy; Distance from nearest well___________________________ nearest buildin ------------ g- -------------------------- El Disfance'fo'rfearest lot line------ --- ------------- 3 ------------------------------y-------------"---------- 9 Remodeling and/or repairing (clescribe� ):-------------------------------------- ----------------- ------------ - ------------:------I--------------- ...... ...........-1-----------------------*------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------ ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------z--------------------------- I hereby certify that I have prepared this application and that the work will be clone in accordance with San.Joaquin County ordinances. State laws,'and rules and regulations-of the San Joaquin Local Health District. 71 ------------------------------- ----(27er and/or Contractor)(Signed(----- --------------------------Ra4---�Ao_t--- ------ By:. ---------------------- -ve- -------------------------------------------------------(Title) -------�_ (Plot plan, showing size of lot, location' system in relation to wells, buildings, etc., can 6e' placed on reverse side). Cl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----------------- DATE-----/- -------------------- REVIEWEDBY---------------------------- - --------------------------------V-------------=--------- DATE----------- ------- --------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ------------------------ DATE----- ------------------------------------------ -------- Alterations and/or recommendations:__:.._.;.----. ----------------=-----------•=-- -----_-_-----------------------------•-••-----•---------------------- --------- - --------- -------------------- --------------------- ---------------- ----------------- ------- ------------------------------ ---------------------------:------------------------------L--------------------------------- . . - r 7f, ---------------------------------------------------- ----------------------- ------------------------------------------------------------------------------------------- ---------------------*---------------11-1-------- ------------------ ----------------------------------------- --------------------------------- ----------I--------------- ----------- ---------------------I------------------------------1------------ ----------------------------- --------------------------------------------------------------------------------------------------- -----------------------I---------------------------- ------------------ Ir q-A e- ,/�< 1,14 . .. AL—INSPECTION-BY:--------—------------------- - -------- ...... Date--------------------------------------------------:----"------------------------ SAN _:------- ------------- 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 Revised W-2100