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APPLICATION FOR SANITATION PERMIT Permit No. Za--- (Complete in Duplicate) Date Issued __YVEI------ 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. JOB ADDRESS AND LOCATION----------C;>?t0. ------ '2 4 ----------------------------------- -- ---- Owner's Name-----------h4ruco------ r"i er---------e 0,--------------------- -- - - - ------------------------------------- Phone------------- --•------------------- Address --------:---------- Address------ ------- --------------------- ---------------•-•-.---------------•----- -_ ------------------- Contractor's Name-------2�•q -------- --- ---------------------------------------------- ----------------- Phone----------------------------------- T ,._I Installation will serve !Residence ❑ Apartment House E] Commercial X Trailer Court El Motel Ej Other F Number of living units: -------- Number of bedrooms .-.----- Number of baths -------- Lot size ---- --------------------------- Wafer Supply: Publiczsystem Community system E-] Private E] Depth to Water Table JI-1-0 ft. Character of soil to a'depth X feet: Sand E] Gravel [] Sandy Loam ❑E] Cla.y Loam E] Clay E] Ado e Hardpan 0 Previous Application Made: Yes E] No New Construction: Yes 0 No FHA/VA: Yes D No TYPE OF INSTALLATION AND SPFCI)IC(ATIONS: (No septic tank or'cesspool permitted.if,pu6lic sewer is available within 200 feet.) 6 ep nk: Distance from nearest well_-_------------_-Distance from foundation--------------------Material------------------------------------------------- No. of compartments-------------------------Size-------------------------------Liquid depth----------------------- Capacity---------------:------- ., Dispos Wld; Distance from nearest well411111 Distance from foundation-----h(D--------Distance to nearest lot 1;7 Number of lines----------/--- ------------------Length of each line-------3_0_�_P------Width of french___.2,Yr--------------------- Type of filter mat Depth of filter material------Ir- -- ---- ---Total length-------3-99- -- -- -----------------;v See" Distance to nearest well---AIPAA��---Distance from f 5c. o nearest lot line_:'-_ ... ....... 2061K.Size: Diameter-_.- -57-2-----------Depf h------- ------------------ A, L Number of pits----_---+------------Lining material------I k Cesspool: Distance from nearest well--'-.---------.- . "Distance from foundation--------------------Lining material---.----.._.----___------------- El Size: Diameter-----=-------------------:------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-___..-.-______-------------'-- ---------------Distance from nearest building---------_.-_-----_---__------------.--._. ❑ uilding------------------------------------------ E] Distance to nearest-lot line---------------------------------------------------------------------I----------------------------- --- ------- ---------- Remodeling and' aae -------- - /or repairing (describe):_r-------- -----:----------------: e- ----- L --- --------- ----------- ------------------------------------------I----------—----- -------------;—---------------------- ------ ----------- t 0�r ---- ... - ------- - --------------------------------------- ------- ---- --- -----------11Z31 1 Eil�` ---- ------ -- --------------------------------------------------------------------------------------------------------------- ----- ------ -------------------------------------------------------- I hereby certify that I have preparedhij! appli`cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and,rules and r +1ons of the an oaquin Local Health District. (Signed)--------------------------------------------- --R-- ---- -----------------------------------------------jOwner and/or Contractor) By:__ ----------------------------------------=------------- -- ------------- --- ---'------- ----- -----{Title)--------- ------- (Plot plan, showing size of lot, location of system in relation to well . uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 14,4&41 - ----- APPLICATION ACCEPTED BY----------------tr-1------------------w--------------------------------------------- -------:----- DATE----------' __'._: --------------------------- REVIEWEDBY----------------------------------------------------------------- ----------------------------------------------------------- DATE------------ ---------- ------------------------------------ BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------ DATE---------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------- ---------------- -- ---------------------------F*#T- --------FhL.LeP--------- -W-1 ------Tn.........RaLK---- IA-S.P ------- I- -------- ----------------------------------- ------------------------------------------------- -------------------- --------------------------------------------------------------------------------------------------- --------------- --------------------------------------------------------------- -------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------ ---------- --------- -------------------------------------------------------------------------- ------------------------------ FINAL INSPECTION 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 1.57 F.O.00.