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Al APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Y� Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and i�stall the work'herein described. This application is made in compliance with County Ordinance No.549. JOB ADDRESS A1111!LOCATION .�-- a Owner's Name___. . ' ...-- l .le5l_.. Phone- Address............... ---------•---- ----------• . ---- .:�,1�.�••1-�.------- ---- ... ._. t " Contractor's Nam e---- ------------- V. t_ t ",. R.0. ---•--- Phone 4,0 I Installation will serve: , Residence A arfinenf House i ' p ❑ Commercial ❑ Trailer Court ❑ Motel,❑ Other ❑ Number of living units: .-.�_ Number of bedrooms____.... Number of s _....__ Lot size ...... .._.."'._......._ 1 Water Supply: Public system ❑ Comrriunitytsystem ❑' Private Depth tb'Water Table _::...._ ft, s ' Character of soil +o a4de06 of 3 feet: Sand ❑ Grovel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ardpan 0 Previous Application Made: Yes E] No ❑ New Construction: Yes N ❑ o ❑ FWA/VA: Yes ❑ No ❑ i r TION AND SPECIFICATIONS:k or'cesspool permitted.if public sewer is available within 200 feet.) 4- �istance from nearest,well.............. Distance from foundation.._....... ....__.Material_....o. of compartments.- � Size - ' Liquid dept -_-•_--_ Ca ,.....-•-•------- ----�--- - • parity..-•----•-•-•---•--•--• istance from nearest well. _ .Distance from foundtion_-_/-__ ___-_.- Distance to nearest lot line -._. umber',of lines...�:...__ ..Length of edch+line__...1- -•-k-`�.__-._.Width of trench_"A,11.�.....�._._._._._ Type of filter material Depth of filter material':. _______ r = ( �: �A= Total length.: p.-•--•-•- ag it: ,Distance to nearest welL,L.Q$--.--_.`•Distance from foundation_.._. e to,"nearest lot line../. • J N,mber• of pits------ ......... ..Lining mate�iai__ .SPC- Si.___. ze: Diameter._. ..�._...Depth.__n�_�1----_---•_.._..- '^i Cess ool ) 1 p ,��Distance from nearest'well from oundation.:.'__._...'____...Lining materia................................... \4 s >t p a. ❑ Size: Diameter....... ...... ;-.._...__�Dept : • ---....-- ................-Liquid Capacity. - ..gals. Privy: Distance from nearest woN.................r..._......__._ -.- .__.-....Distance from nearest buildinl ❑ Distance to nearest-lot-line----•-.7..: ,:..... :: + _ - -•--------•-•-••-•--•------................... ( - i ---- . -----•---•. Remodeling and/or repairin descilbe): _ �t i , .. t ----------------------••.. ` � --•--- .-•-- -•-._...... I herebyY r 'y,that I have prepared his•! plication and +hat.+he•work will b done in accordance with San Joaquin County i. ordinan St aw d rules and re ulations of the San Jo quip oral Health Di ' t. e Si ned 1 f!�!(� ; ( � } - I .... .....---•-•--•-.:� _ �_.. . ... - ----- --- •---......----- r Contractor] By:--------••- --_---=•----------------•-•-...... :.._....._............_..-- - ------ Itle}---------------------------------------------------------------- (Plot -plan, showing size of lot, locetion'of system in rela ' is. building-s. c. an be placed on reverse side). ~ F. ' . - DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY........ - DATE---._..L.../._� �... REVIEWEDtBY..------------_-- ' - .•:. �"` .. �)r`l .•---------------------------------------- DATE--•••• �: .. BUILDING PERMIT ISSUED i ----------- ----••----------------------------•--------- DATE.......---..... Alterations end/or recommends+ions:........... ......•.. '.•---...............-•---........• n..•-----•----•••...............................••-•-•---...........---- (t o -_...--•---..•......................................... .-... .......................7.-•--•-••--........--•--••--••------ ..... q,�& = tt .........................•................................................................................. r 1 c 1 1 FINAL INSPECTIO - - Date_---:-_=•1f---- ___rs. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A , Roviseci 1.57 F_P.CO.