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er 1_� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---- P lica+ion is hereby m ade to the San'Joaquin Local He'alfh District for a' permit to construct and install the work herein described, T is application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION.-I---70-1--- JL. -7------------------- ------0_7-- --------�- &-;X.- Owner's Name----------66-WO-1 Y . Address.-----------•--------------------------- Contractor's ddress.---------------------------------------Contractor's Name-------------------------k�'140_1_s --------------------------------------------- Phone 101?p Installation will serve: Residence A Apartment House ❑ Commercial 11 Trailer Court El Motel IJ Other El Number of living units: ___1_ Num- lber of bedrooms .,R__ Number of baths __{__ Lot size ------------------------ WaferSupply: Public system ComF ._.,R,_&y9f`8ffi-R Rfiva.*601�t Depihi- W-iac Ia- Character of soil to a depth of 3 feet: i and ❑ Gravel E] Sandy Clay-Loam El Clay El Adobe 59- Hardpan 0 Previous Application Made: Yes. No 'ructionEl &Uf leme—A+4" TYPE OF INSTALLATION AND ;PECIF;CA- ONS: 'C 1.1.4-No septic tank or cesspool permii fed is sewer is available within 200 feet.) we ----------------Distance from foundation-------------------A ater'al------------------------------------------------- Ti Distance from 8res weWID I No. of comp nt� • --------------------Capacity----------------------- Disposal &�d: Distance from e re wel .... Distance from foundation________-,------- to nearest lot line-----------------113 Number of lir is - -- -------- - ----- ngth of Ach 1-ine-77t-------:—-------____.Widfh of trench.----------------------•----------- I f-It t� .j Type oT i er e ------------------------ of filter mater ------------—-------T)ta) length-------------------------------------�;_ Seeif Pit: _ 'Distance'fb n 5f V ell-mv cj._.. ...r I y4fionce to nearest T n=OU --------- Di�fwr T'-u- L idatic�n -est lot line----/0------ biamet,r-4 Depth--- Number of p! - --__Lining ri�iater a Size: -- ---------- ---------------- Cesspool: Diifance fro llelr�e f well____--------......Xist ince rn fou,idation--------------------L fining material--------------------------------"_"--, T 7 Size: Diam A e ; 0 m---- ---- ---7--------�-----------Dep h--------- M------ L quid Capacity- --------------------------gals.< ----- - I Privy: Distance fro arewell------ ---------Y------ ---------I------------ Distance frornear st building--------------- ------------------ El Disfance f�j_n a esf.: Df,lire.:,!_-------------------- -------------- ------------- - ---------------------------------- -- ------------- ,pairing jcI4 d1j.------- -------------- ----------------------- -------- ......... ------ Remodeling and/or re ------------------------------------------------------- ------------------------------------ ----------------------------.......!n---------------- ------------------------------ ---------------- -------------- ---------------- ------------ ------------------------------------- ----------- ---------------------------------------- ----------------- -------------------------- ------------------------------------------------------------ -------------------------------------------------------- ----------t ------------------------------------------------------------- --------------- -------------- ---------------------------------- -------------- I I hereby certify fha ' have rep 4:1 f * applicafio and-that the-work will-be done in accordance with San Joaquin County ordinances, State la a rules and ula ns,of the an Joaquin Local Health District. ----------- app ica�'io ns.oj f the (Signed)---------------------------- ---- ---- --------- - --- ----Z------------ ------ - ------ ------------------------- - -------j(0WTM9;Fx;;46;Pr Contractor) By----------------------------------------------------------------------------------------- V_bAlfrar------------------------ C (Plot plan, showing size of lot, I cation of system in relafion_f\o �ells, buildings, fc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------------------------- -------------------------:--------------------- ---- DATE----------- F tll��e I -__/---------- REVIEWEDBY---------------------------------------------------------- --------------------- --------------- ---------------------- DATE--------------------- BUILDING PERMIT ISSUED--------------------------------------------I-•----------------------------------------------------- DATE---------------- Alterations and/or recommendations...................... ------------- ----------- ---------------------------------------------------------------------- ------------------------ ------- ------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------ ----------------------------T---------------- --------------------- ------ --------------------------------------------------------------------------------------------------------------- ----------------------------------- I----------------------- -------------- -------------------------7------------------------------------------------- ----------------------------------------------------------------------- .......... ------------------------ ---------- 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-9-2M ; . Revised W-2100