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APPLICATION FOR SANITATION PERMIT Permit No. �� (Complete in Duplicate)T/1 Date issued .__ __�___l.16c This'Permit Expires 1 Year From Date 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 JOB ADDRESS AND LOCATI N ---ALU= --6----`-------- ---- uw --- -- �-n----- --lI�.�-.--------------------------- •.x -------------- Address ------------. Phon "jf:._s G !. Owner's Name----- -� •---- •--�-�.�-�------•- -• ---- Address--------------------•--- �/ -- ---=-.----¢ - 6X1_4 - =-----------------------------------••---------- -----•----------- ---- F - = Phone_. ' ___�__ l _ _ Con#ractor s Name--- ------------ - d��------------- ••------------------ ------------------- ._ ❑ ❑ fes" -.---0---• •----- -• Installation will serve: Residence ❑AApartment House ❑ Commercial ❑ Trailer Court `Motel; Other Number of living units: ---V- Number of bedrooms •. ___ Number of baths t_ L* Lot size ------- P.-7- ------------f---=------ Water Supply: Public system ❑ Community system [I Privateer'- epth'to WaferTable,Y,7ft. _ _ Character of soil to a depth of 3 feet: Sand ❑ Gravel L] Sandy Loam ❑ Clay Loam I] Clay ElAdw � - Hardpan.❑ Previous Application Made: Yes E]No ew Construction -0 Yes eo; FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Material __ Yl - e--r------ Septic T Distance from nearest well__ ---- --__ Distance from foundation__/ No. of compartments.-- --� _ .--- ----Size-- ----------Liquid depth'_. -----------Capacity_ _ c` Disposal F• '�� Distance from nearest welL!......... Distance from foundation --/4e ------- 5�'_.0_108nce to nearest lot .line ................. Number of lines---.----- c; -------- --- ------ Length of each line ----- ^ '------------Width of trench __a_ ----�.------------- ----- Type of filter -- --- of filter material___%_L{'...__,__.__Total length_.__o? Q------------ -------:---- Seepag i Distance to nearest well._ _d -------Distance from foundation--/-d-_.__-----.Distance to nearest ll line �______- W I Number of pits.-.___L�-.._------Lining material_-e_C_ tom_ ---Size: Diameter___.__ - -Depth_% ----------- '------ Cesspool: Distance from nearest well -----------------Distance from. foundation ------------------- Lining material.._.------.-----_-_--_-----.- _-.__.. ❑ Size: Diameter--------------------- "` Liquid Capacity als. Depth --------------- g Privy: Distance from nearest well -----------------------------" --=----------- `Distance from- nearest building.:----'.--.------------------------------ � ❑ Distance to nearest lot line--------- -------------------------- "------------------------------ ----------- ---------- _�----------------- ------------------------------- i '----------- ---- ---- �� Remodeling and/or repairing (describe):_ ._. •��]�E'4"` -- --=- - ------------------------------------------------ ---------------------------------•---------------- --------- --------------------------------------------------- ------------------------------------- -_--------- ---...------•--',,---------------------------------------------------------.-------- _ f 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, and rules and guI tiorisr.of the San Joaquin Local Health District. '•� wrier an Contractor) (Signed)----------------------- � ---------------- -- (0 and/or C nt G ---- { p L✓ -] - (Title) __------ _ } (Plot plan, showin of lot, ocation of system!inrelation to w Ings, etc., can be laced on reverse side. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------------------------ DATE- �r',�--------- - REVIEWEDBY----------------------------- ------ DATE----- ------•---- ------------------------------------------ BUILDINGPERMIT ISSUED------------------------ --------------- DATE------------------------------------------------------------- Alterations and/or re mmdatons:- - -- ---- ------ -------------------------=_----•------------- ----- ------ / /Q ------------ --------- �y. FINAL INSPECTION -8.._ ; F Da.te----------- -tel d---------------" ==>---------------- 130 South American Street Stockton, California ES .9-2M Revised &'59 F.P.0O3 SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Street Tracy, California