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APPLICATION FOR SANITATION PERMIT Permit No.,�' (Complete in Duplicate) �( _7 g ,�.w ba _ _ to Issueds__► 4 S` Applica+ion 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. 54 M JOB ADDRESS AND LOCATION-- Air 9-- - -- r - - "---- 7a_a------- -----------------x------ Owner's Name - ---- - Phonet217e' ------------ {w ! / -------------- Address----------------•-------•------•------- ---J7� fal-+` - - -- �Contractor's Name-----s------------------ 1"� ---r-.-.z..- --------•-------------- Q >�� ' Phon - Installation will serve: Residence X,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ _ Number of bedrooms _'Number of baths ___ .. Lofsize _--- 'x-_1__.7--'= ..-_.-______ Water Supply:' Public jsystem-❑ "Community system•❑- Private P Depfh to'Water"Table---"--- ft, Characterof soil to a depth of 3 feet: 'Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,)C Hardpan ❑ Previous Application Made: ..Yes ❑ No New Const ruction:=Yes ❑ No ❑ 1"rjy" gj-r CU TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic fankeor cesspool permitted if public sewer is available within200feet.) is ank• ti Distance from nearest well -- ._Distance from foundation_-_-___-r__..-------------------_.Material------------------------------------------------- No -_. _____ _ ___________No. of compartments--- Size------- ------ ------ ---Liquid depth--------------------------Capacity------------- --- i s . «^i Disposal Field: Distance from nearest well.... Q Disfance from foundation_ -_4----_____-Distance to nearest of lin�_______________ Number of.lines____________ _ _ __ g ' • Width of tren Len th of each line___-- - --._ ch___ _--_�.__--_-----_----_-- ' -Type ofilter material__- Depth of filter material-_-. Total length_____ ---------------------------- I F - - """ � -"-"-""--- i Seepage Pit: �.Distance�ta neatest,well________ _____Distance from foundation-........._.....__..DistancWto nearest lot line________________ ❑ = Number--of'pits------- ------Lining rnaterial--------------- -----Size: Diameter-- ----. ----- ----------Depth-------------------------------- * .. Cesspool; Distance from nearest well-----------------Distance from foundation----------_----____'Lining material_________-____-____-_____________:_ } ❑ Size: Diameter--- --E------ --- -Depth-----------------------------------..........1-=--'Liquid Capacity------------------------------gals. T. Privy:` - Distance from nearest well .._-_:___--_ _4.----------------------------- _Dista_nce from innearest building #__ ______ _F_____________ ❑ ----------•--------------------_ '---------------------------------- ------------ Remodeling --- -- -- - '~ - � Distance'to nearest lot line�'--"•"�°' - __- _____ _ Remodeling and/or repairingr (describe)---------- ------------ --------' -----------------------__-_--------__ --- ------ _------------- - - - * y w - Lhereby certif I have=pre pared this application and,fhat the-w`ork will be done in accordance with San Joaquin Cdurt-fy- ordinances, Stafe_,la s, an ,rules-and, regulations of the San-Joaquin Local Health Disfrict: ' (Signed)---------- ------ -- l ---------------------------------t • ( Contractor) By: ___ --•-?----- ----` ---------------- --._Tiile 1017 - -Ql�- -------------- - k ( plan, g F .ayst in relation to w Is, buildings, etc., can be placed on reverse side). Piot tan, showin size of lot, location of FOR-DEPARTMENT USE ONLY {' APPLICATION ACCEPTED'BY_--- ------------------- - -- ---- - --- .1� --- e -----".-, �--�---------�' -- ---�--"-_-'------ ---'�-=--=--'-----�t------------------------- DATE:------`S/_-_-----��--------------------- -- ---------------------' -- ----------------- D'ATE == ------------•-----------)----------- REVIEWED BY----------------------- DATE--=---------------- �._.----------------------- BUILDING ------------=--•------- BUILDING PERMIT ISSUED; ..:_... - Alierations and/or recommendations: _ _ ' _-_----_--_-_ ---------------------- ------------ ---------------------------------------- - i.E'�4 ?� _ _ _._-___-__ _ ---------------------------------- _ _------------------- 577- ------------------ ________________ �_______________ ___________________ a �� giv ---7 r - --'3 ---FV. ----------- �. .d'Al FINAL-INSPECTION, BY:-" ,.. --------y--= Date-.-" ------ ------------------- ---------- "SAN ------ "SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-72M Revised W-2100 r.