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r s �� APPLICATION FOR SANITATION PERMIT Permit No.3_�_______________ 1 (Complete in Duplicate) �� 3 Date Issued _ _i--/-�. 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 Ordinance No. 549, JOB ADDRESS AND LOCATION) 2___ - - -----19M.t-0-6-G-r-/ Owner's Name---------------------- I - Phone_ ! _ , -------- Address-------------------------------------------------- 1.J72-a- Contractor's Name-------------- ---------- ftefkLa - C� --..__ Phone__5;177 Installation will serve: Residence Dit Apartment House ❑ Commercial E] Trailer Court E] eMotel [IOther ❑ a Number of living units: __/.__ Number of bedrooms _1-.. Number of baths J... Lot size ---_ ---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.____�tit�' �� 7(-t � Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam E] Clay Loam E] Clay E] AdobeN Hardpan E] Previous Application Made: Yes ❑i Noa�L_ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I 4 tic T A. , Distance from nearest well-----------------Distance from foundation_-.-__________.__-.Material _._- '�` No. of compartments--------------------------Size------------------------•-------Liquid depth---------- ---------------Capacity----------------------- € D osal Fie€d: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__-----_________- Id Number o� lines---------------- ------Length of each line---------------------------- Width of trench Type of filter material-------------------------Depth of filter materia-----------------------Total length---.----------------------__---_---------- �/ i Seepage Pit: Distance to neates,,well__IB -___Distant f o fo ndation--,� •_ __-_.Distance to nearest lot ------------ Number ___-- Number of pits--- Lining material__ _ Size: Diameter_____ p __� W Cesspool: Distance from nearest well________________Distance from foundation------------------- Linisg materia 'I__-______- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------- ------------gals. Privy: Distance from nearest well________________________________________________ Distance from nearest building------;---------------------- ❑ Distance to nearest lot line_________________________________ Remo`c/ljn '•+� ---- -------S_ ------- -g anarreparn ( escri /) 4 ------- -------- -----------4 ---------6e-7l_ ----- _---- le --------- \•,fr I hereby certify that I have prepaPr application and that the work will be done in accordance with Sara Joaquin County ordinances, State laws, and rules and ons of the SanrJoaquin Local Health District,[Signed --------- --------- ldi �` C--''----------------------------- ntract BY. �. --------------------------------------------------------------------------•----------------------------(Title) ' -------------- R (Plot plan, she ing size of lot, lot i n of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY [ APPLICATION ACCEPTED BY--------------------------------AA.0 ----------- '--------------------------------- --- DATE-------------- ' k REVIEWED BY----------------------------------- DATE " BUILDING PERMIT ISSUED------------------------------------- = DATE ----------_------------ Alterations and or reEomm ndations:------^-----•--------- -------------------- --f=- - ---- ---- _ -i . ------� -------------------------------------- - 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 ES-4-2M 10-52 Revised W-2100