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t/ FOR-OFFIC USE: . - ------ - ---- ----- APPLICATION FOR SANITATION PERMIT USE- Permit N°' ------------- --------------------------- ------------ 7/26 (Complete in Duplicate) Date Issued ---------------•-----• --------------------------------------------------------- --------------------------- ---------------- ------ 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. S49. , i �h — p --- JOB ADDRESS AND LOCATION_________ /�y' � t ------ Phones Gtf�7__._ ------------------------- --------------------- 1 Owners Name.---/=✓�.�_._:G-'.__..Q----------- - - =-�r�-'--- Address------------------------- - - - ---I----------------•--- -------------- - �c`�� ,��h�_4�`_.l-•--�ll�_r----•---•---•--•-----•---•--------------- Phone._._..._�r�..� --------• •- i Contractor's Name. 1�- ---- Other Installation will serve: Residence K Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Number of living units: .-!----- Number of bedrooms .--2----Number of baths __/-__ Lot size ....... Private ❑ Depth to Water Table _aft• Water Supply: Public systemCommunity system C3, Adobe X-Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Previous Application Made: (If yes,date--------------------) No�Ne`"' Construction: Yes ❑ No i �tA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic r Distance from nearest well-________________Distance from foundation__.-----------------Material No. of compar#mems - Size------------------------•------Liquid depth--------------------------Capacity---------------------- $nz�_Distance from foundation- -- -- .Distance to nearest lot line------ -----••- D sal field: Distance from nearest well._ --_---Width of trench.___-5 '�--------•----•- (� Number of lines Length of each line ria!- ----2x1 } Type of filter material-.__ R1------Depth of filter mater;al___ •-�-s�- --_---Total length----------- Q .._ .g � (y� Seepage Pit: Distance to nearest well- !Ars -----Distance from foundation-___fp..__..Distar<c to nearest lot line-�_---4------ Number of pits._.__ -- ------Lining matersal_. Size: Diameter___ ___------Depth____- _ _----------------- --- .___ ------ V ---.Lining material Cesspool: Distance from nearest well------------------Distance fom foundation---------------- Capacity gals. ❑ Size: Diameter._-------------- --=----- -------.Depth -------------------------- ~� Privy: Distance from nearest well-----------------•-------------------------------Distance from nearest building------------------------------- --- ❑ Distance to nearest lot line---------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- -- --•-------------------•------j % - .--- ----------• - ---------- ----------------------- -------- ------- --- I hereby certify that I have prepared this application and that the w will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the.San Joaquin Local Health District, ,• _ �1'!Lr_e- ---------------------------------( Contractor) � _�c_ (Signed)--- ZE ��-� -- -� ------ -� By------------------------- •---------- •----- (Title)----------------------------- - -- --- --- -------------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, a Z. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- ------- -- DATE-----�--- REVIEWED BY `----------------------- - ------ - --------- -----------------------------------•-- ---- DATE._ --------------- * k ----------• DATE--------------- ------------ --------..------ BUILDINGPERMIT ISSUED----------------------------------------------------------- - ------ Alterations and/or recommendations-----------:r----------- ---------------- _ _P ` 'd r - Z� --------------- -------- --------------------=--------------------- -- ------------------- --- - ----------•----- r FINAL INSP - -------- -- - Date 0 SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 300 West Oak Street 124 sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ` Es9.9 REVI9E0 a-59 P.P.c D.aM 6.60