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APPLICATION FOR SANITATION PERMIT, Permit No. .__ —3__F->-- (Complete in Duplicate) t� Date Issued ___ Applica4ion is hereby made to the San Joaquin Local Health District for a permit to co)s�uc n st �th�w r re rib d. This application is made in compliance with Count dinance No. 549. p1� JOB ADDRESS AN LOCATION--- 11t)-�_..._ ��1,�,�------�Q._W L �� -J--Q gyp -' Owner's Name_-._--- -- --i--E71----- .. �+'�_)_..._.�_[�F'a.'--------- ------ ---- Phon ry t 1 Address__.--�'-`-------------V�...�_t__ X.__ -L-1----:-�-----,�---�:4-/��f--o�. Contractor's Name '� - �� 1 a_._ 1[ ------------------------------------ ---------------- Installation --------------Installation will serve: Residence OR""A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: I---- Number of bedrooms �-- Number of baths _1__._ Lot size .____ Water Supply: Public system [[Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe kQ-Hardpan ❑ Previous Application Made: Yes.❑ No New Construction: Yes ENo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_-. rw---Distance from f undation__t _____.Material._.- ____.__ _ . _ ___ __•'---- ----- ----- No. of compartments_.._______ ____ ___Size _�, _�-.Liquid depth__, ___ __.�! ��_ J 6�`# '" I ----- Capacity-� ----�_�'____ Disposal Field. Distance from nearest well.!`tiixQ/.._Distance from foundation__ 4...._____.Distance to nearest lot line__- ; ❑j� Number of lines___.__!_____.- ____..Length of each line___ _ g ----------- LrenrType of filter material_ .. Depth-of filter material. "....__ Total len ___ .� � j Seepage Distance to nearest well_I�- -Distant rom oundation__ ___ ._..._--.Dist N to nearest lot line__--_�---- Number of pits--- Lining material_------Size: Dia meter__.-.---_-Depth.e�1r_01M11, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_----___...____ \ ❑ Size: Diameter------------------------- - ----------Depth- ------------------------- ---------------------Liquid Capacity----- ------------------gals. \ Privy: _ Distance from nearest Well.---------------_--- ----- ---------------- -Distance from nearest building______--------------___---------__...... - ❑ Distance to nearest lot line- ----... Remodeling and/or repairing (describe):__-__ ------------------ - - • -- ---------------------------------------- --- - ---- •--- -- ------: -------- --- ----•---- ------------------------------------•---------------•---------•--------•----------•---------•----------- - ----------------------- ---------------- -------------------------••----------------•--------•-•-•------------------------------------------------------------L-..................................... ------------- I -••-----------•- ------------ ---------- -- 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 regulations of the San Joaquin Local Health District, DAY& NIGHT (Signed} E -SVfir-Tam-Service------------------------ -- - ----- ----- --------------------------------------- (i�'iwwre*ehLa Contractor) a 206 So. Eldorado HO 2-704b _ J $y' Title ___ _ St CkfiBh;CyiF- ( ] j (Plot plan, showing size of lot, location o-f system in relatio o wells, buifdin s, etc., can 6e placed on reverse side]. FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -------------- By --- ----- DATE- 9 BUILDING PERMIT ISSUED ---------- --------- ------------------------------------ DATE----------- ---C-------------- - ---------------------•------------------------------------------------------ DATE Alterations and/or recommendations:--- ----------------- ---------------••-------- t - -� .. . --------- --------- --- ----- ---- --- -- _ --�- -- - = J ---------- sem-.. _- . .- - - ----------- --------------- ----- -- -------- ------------------------------- -----------------------•-- -------------------- ---- ----- - -- FINAL INSPECTION BY:--- 2 Date. ---=------' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 Nor+h "C" Stree Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 A7WO9O 12.54