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APPLICATION FOR SANITATION PERMIT Permit No.�_._..�. _..�__.. 1 ` + (Complete in Duplicate) 6 1 X v Date Issued . -dP ',_ / 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. 549, JOB ADDRESS AND LOCATION_.. __ _�_ //�� 1" 71 ° -- 1 Owner's Name '�[�1-�- !� _,.�. ----- - --------------------- Phon ,� i"'I_ "��"` ,� -----. 49 Address = �---- ---..4 _ � lr -- -- ------------------------------ -------- ---------- Contractor s Name :. Nle `. -OW—4 ----JE- f ---------------------------------- P n ---------3'4Qry--- Installation will serve: .Residence Ey Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J' .r.,� Number of living .units: Number of bedroom_ _-- Number of baths _ Lot size ---74----_-A---I'-v---------------------- Water Supply: `Public system Community system ❑ Private ❑' 'Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ �dob,%XN Hardpan ❑ Previous Application Made: Yes ❑ No/.New Construction. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic`tanVor cesspool permitted if public sewer is available within 200 feet.) fptnic Distance from nearest well from foundation_-------_-- ---.Material____---- ---.-_---_--_----------_--..______-___. II No of compartments---------------------- ----Size--------------------------------Liquid depth---------------------------Capacity----------------------- s d Distance from nearest well---------------- Distance-from foundation.------.__---..----Distance to nearest lot line--------- % ---------------------Len Length of each,line----- `------ C �"� Number of lines-------------------------------------- g ________________Width of trench.--------------------------------- Type of filter material----':- ----..•Depth of filter material-----------------------Total length--------------------------------------__-- Seepage Pit: Distance to nearest well_�"'�B_4��Disfanc fr qfoy-ndation-140-_--._..Dist nce to nearest lotNurnber of pits_---/--------------Lining material�d __.Size: Diameter__ -r!_____Depth___ f r Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material.----_-----------.----.-----_-_----_. ❑ Size: Diameter--------------------------------------:Depth------------------ ----------------=---------------:Liquid Capacity-----------------•--- gals. « Privy: Distance from nearest well----------------'---------------------------------Distance from nearest building------------------------------------------ ❑ �-- .Distance to nearest lot line---_--_-_-:-_---:::-------------------- - - Remodeling and/or repairing (describe):----------------------------------------- ............. ------••------------------------•--------------------------------------------------•---- ---------------------------- ------------------------- --- -------'----------------------------'-----------------------------------=-----•------------------------------------------------------------------------•----..--------------------------------- �n I hereby erti y that Ih ve pr red this application and that the work will be done in accordance with San Joaquin County 7�+ ordinances, S to wsi and les an regulations of the San Joaquin Local Health District. d - - ------ nc.--- --- -------------- --------------a----------- ----- Contractor (Signed)......... -- •------------------------------------------------- ----�-=---------� Is� ) By------------- -- -------------(Title)- r1"�� lfl-�`----------=---------- (Piot plan, showing size of lot, location of syste relation to --Ti uw ings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- :- '---------- _A DATE------------- ---4 __________ REVIEWEDBY ----=----------------- ---- ----- --=- ------------------------------------------------------------------------- DATE------------------------- --- -------------- BUILDING PERMIT ISSUED-----------------------------------------------1_ ------------------------•-I-- --- ---.....---------. DATE----------- -------------------------------------------- Alterations and/or,recommendations:------------------------------------------------------------•---•-----------•---------------•-•----•--•-----••-----------•-........---....--------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------•-•-------•--------------- ----------------------------------------------------------- --------•- ------------•----------------- --------------------•------------------------------------------•-•------------------------------------------------ j f FINAL-INSPECTION BY:- :'_ 1 - Date------. .� ,U-----=- ..t------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oat: Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100