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PeKmit No. PLICATION FOR SANITATION PERMIT ' (Complete in Duplicate) pate Issued 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. r JOB ADDRESS AND LOCATION------1/-.9/_�I---.---��- 1- --<P- f-'-�g------ ,----�=------- Owner's Name'-►. ---------�'---- :_ _� Phone--7 -7_ � Address-. -- `` - -------- ----- �R-�l ----- . -------- --- ------- Phone---- 3 = Q. .------ Contractor's Name-----------------•-- ----_ --------- - Installation will serve: Residence V Apartment House ❑ Commercial ❑ frailer Court ❑ Motel ❑ Other ❑ L.--_ Number of bedrooms _ _ Number of baths -Z__ Lot size ._-___ L-' ' -'----------------------- Number of living units: _ - - Water Supply: Public system ❑ Community system ❑ Private X,7 Depth to Water Table .- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Clay ❑ Adobe+Pj Hardpan ❑ Previous Application Made: Yes ❑ 'Noi4, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 felt.) Septic Tank: Distance from nearest well �_____--Distance from foil at'on �1�j Material------✓""` "k 4 - ---------- q p --- Capaa+Y6" rj .. No. of compartments________________Y---Size �--�- ----------Li Liquid depth Disposal Field: Distance from nearest well Di .3 from foundation -_-_Distance to nearest lot line.-/1_O_....... Number of lines____---------- -�___�___Length of each line_?- -__- Width of french---ZA_V-!{-------•------- Type of filter material._ _---- c__Depth of filter material___-__� ---------Total length- --------------------------- Type Pit: Distance to nearest well_ZP4:Z----------Distance froom+ found'ation_7�?.---_-.---Distance to nearest loft line--/e------- -----_--Lining material- �C__---Size: Diameter__�As------_.Depth---A °---------------- �. Number of pi+s___._/_-.- Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining materia------------------- gals. l � ❑ Size: Diameter-.-------------------------- ---------Depth--------------------------=-------------------------Liquid Capacity---------- -----------------9 V' Privy_: Distance from sorest well--------------------------------------------------Distance from nearest building_______.--_____--------_----------------- ' ❑ ---------- , Distance to nearest lot ine-------------------------- ------------- ------------------ 4 Remodeling and/or repairing (describe) ------------------------------------------------------------•-------------------------------------------------------•----------•------------- C ------------------------------------ -------------------------------•------------I------ -- --------- ----------------- — — I - �. ------------ i - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ! ordinances, State laws, andi.rules and regulations.of the San Joaquin Local Health District. --- �-"`Y" �•- - (Owner and/or Contractor (Signed) - -- ---- lht�= --�------------------ -------------------------------------------- -- f �� -- - --------------------------- IIs build-----setc.-- -- ( ee lac ver s- (Plot plan, she" ing size of lot, location osystem �n relation to e buildings, canbe I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE- ----------------------------------------------------- REVIEWEDBY--------------------------------- ---------------------------- --------------------------------- DATE BUILDING PERMIT ISSUED----------- --- --------- ----------- ------------ ----------- ----- ----------------- DATE--------1U-e------------------------------------------------ Alterations and/or recommendations---------------------- - ----= ---------- ------------ ----- ------ ----------------------------------------------------------------- -- ----------:---------------------- Date -------------------- ` Date---------�- .f ---------------------------- FINAL INSPECTION BY----------------- ------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi California Manteca, California Tracy, California 3=S-9-2M 8-51 Revised W-2100