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X APPLICATION FOR SANITATION PERMIT Permit No. �' S'=7__� (Complete in Duplicate) S� /� Date Issued ----- f___5 r 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. �* e JOB ADDRESS AND CATION-__•_------_--" --------I- � _-- - ------------------------ Owner's Name--- -- "�------------- r Phone ------- �f---- Address---- ----------- ---- --------- - Contractor's Name-- 4--- 1- k------ - " C.+ --- ------------------- Phonav ------ Installation will serve:- Residence X Apartment House Commercial ❑ Tra``iler Court ❑ Motel ❑ Other [❑ I. Number of living units: "_� Number of bedrooms Number of baths .ef_tet size ------� 7f_lex------/ c Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 3f New Construction: Yes ❑ No FHA/VA: Yes ❑ No ir TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitfed if public sewer is available within 200 feet.) Se tic Tan . Distance from nearest welt___"""--__--_"_"Distance from foundation_"""_""-..-_----_.Material Do1,S11)? No. of compartments------ -------------------Size----_---------------------------Liquid depth-------------- Capacity Dis o sal Field: Distance from nearest weiL Distance from foundatio _ Distance to nearest lot line"_ ` IERW* Number of lines----- �--- -------------"-_ _--Length of each line---. 1�_!'--------.Width of trench.- 4-� Type of finer material__ ---Depth of filter material_-_". f�---_Total length--__---- Q__ 1 ----------------- See e Pit: -------------- Distance to nearest well" _[ __ ____Distance from foundation---� Distance to nearest lot line---if � Number of pits__"�._____-_.--____Lining material" _Size: Diameter_---" 11 De th_... e______________ Cesspool: Distance from nearest well------------- Distance fra foundation.--_--__---.---___.Lining material------------------------- "---____--". l ❑ Size: Diameter--- -------------------- -------Depth- -------------------------------------------------Liquid Capacity---------------- gals. Privy: Distance from nearest we fl "____-." Distance from nearest building------------------------------------------ Distance to nearest lot line- ------- -------------------- --------- --------- ---------------�- - -----------=--------- - Remodeling and/or repairing (describe):___ - -- ------------------------------------- - --------------------•----------••-----•----------------•-----I ------•, - _ ------------ ----------•---------------------------------------- V09 ------------------------------- --- - - ---- ` A_ --- C J IJ '----------- - --- ----- .----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County k ordinances, State laws, and rules and regulations of the San Joaqui al Health District. N + yy R 1 (Signed) ----- 4-C j`j � _ Contractor] --- ----------- By:-------------------------- ----------------- -------------- ----------------------- (Title) (Plot plan, showing size of lot, location of system in.relation f ells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ,- .�©_-"---------------------------------------------------------------------- DATE--------` -" /~ `j REVIEWED BY---------------------------- �"--------------------- - - ------------ - ----------------- ------------------ - ------- DATE-------------- �-------- --BUILDING ----------------------------------- PERMIT ISSUED--------------------------------------------------------------- ------ DATE- I - --------------------- Alterations and/or recommendations:----------------------------------------------- -------------- -- --- --- -- - --(x-- ----------------------- ---- -5 - --------------------------- -------------------------- ------------------I------ ---------------------- FINAL INSPECTION BY:. Date - F SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 , Ravisea 1-57 F-P.CO.