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APPLICATION FOR SANITATION PERMIT Permit No. ,3..? ... (Complete in Duplicate) 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 eADDRESS AND LOgATION------------------------�a.(Q-------C� ,a: T ^. r.5'Name = v,J � vS ,_U -�/2i�-------------- -- -- Phone--_Z-AV-P- 1 Addresser"¢' o' •--------:ems ------------- -------•-------------------- -------------------------------------------- - ---•---------------------- Contractor's Name -------••-----------•---------------- /-v------------------ j----- Phone ------------------------------- Installation will serve: Residence„k' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _1, Number of baths'-/--- Lot size ------ Water Supply: Publiclsystem Communit �s stern' .� y y ❑"Privafe❑—D6pth to Water-Table ________ ft. Characterof soil to a depth of 3 feet: Sand [] NGravel ❑ San Loam ❑ Clay Loam ❑ Clay ❑ dobe � Hardpan [f , Previous Application Made: Yes ❑ No 5d New Construction: Yes a No ❑ s � TYPE OF INSTALLATION AND SPECIFICATIONS: , No septic tank or cesspool permitted if public.-sewer is available within 206'feet.) i 9 r � S Sep Distance from nearest well_____N'______Distance from foundation------10_. ___i.Material_____.-_____.____ No.iof compartments------- y_-..----Size___,- k ---Liquid depth_t74w ---.Capacity as Fie Distance from nearest well______ Distance from foundation _-. ___..._Distance to nearest lot line_______ ____ Number of lines--------- 1�t Length of Jach line----------6d-------------Width of trench......-__ ______ _ _1- `�- Type of filter material _ �_1 epth of filter material____._____-/4-4--Total length------ -.____ ------------------ w Seepage Pit: Distance to nearest well_-_-------------------Dysta`n'c6 f41rM foundation_____.______..._-..Distance to nearest lot line---------- ❑ Number of,.pits------- _____________Lining material__i___-____ -.------Size: Diameter----------------------- Depth ------ Cesspool: Distance4om nearest well` .__'_._.Disf&ce from foundation..-_----------------Lining material__l_____-__-_____._____._._------__ ❑ Size': Diameter------ ----- t..�«..,,,.� ------- - -• ---------- Depth ; Liquid Capacity F --gals. Privy: Distance from nearest well_______________ ) f Di _ stance from nearest building ----------------------------------------- ❑ Distance to nearest lot line--------- Remodeling and/or repairing (describe)_.-;,,,,,,________________ _ _ ___ ___ ___ , I _ sr ________________________________________L_________-__ .4 ____..--_________ _-_ __-___-____ __ ___.______-____________-_-_ Y Y P Papplicationw ---------- ------- I hereby certify that I have re aced this and that the work will be done in accordance with San Joaquin County ordinances, S e laws,land rules and're ulations of the San Joaquin Local Health District. ---- 5i ned I 9 ) ----- --- -- ------- ---- -•-•�---- ---- •+F.A��---------- -------- ------- - - --- ----------[Owner and/or Contractor) BY� •----- ' Tale ----------------------- (Plot plan, s ing size of lot, location ofsystem in relation to wells, buildings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY--------------------- DATE_---- REVIEWED - _----- 4 a 44,_ ------------------ V ------ •-- ---- D BY------------------- •------------�---- ----- - ---------- ------------------ - --- ----------- -------------------�----- DATE--------�---- ------------BUILDING ---- PERMITISSUED-------------------------------------------------- - ----------------------------------------------- DATE----�-�-------- --------� --- -----�----�--------------- Alterations and/or,recox.m enclations:-----_.-_____.____ ---- --------- -----------• _ --------- ---- '11011 ti -- ---c---- A, -----------------`'. ' �1. '`" - .---•--•-- 44.1; -------------- c a ar +.�_ fka -Cath - ,�c FINAL INSPECTION BY:..------ �' !-7.(ih Date..------- ----------------------------------- SAN 2 JSAN 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-4-2M 10-52 Revised'W-2100