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Z� APPLICATION FOR SANITATION PERMIT Permit No. _.__Z.e_j_3 .. (Complete in Duplicate) - pate Issued L_•-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d scribed. This application is-made in compliance,with County Ordinance No. 549. ,J — O.� C f' JOB ADDRESS A LOC T10 ,__.. . -------- .............}�-_- - ......---t ---------------- Owner's Name.... !. 0 f...._. __'.. Phone...... --••-•-- Address......- _ .. •---•-•••-• ----------•-•••••••- 1 Contractor's Name........:-.... ......... t Phone................................ -•- il Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [� otei ❑ her ❑ osize ..-- ---------------•---- Number of living units: ._-_�H Number of bedrooms __...... Number of baths _ ..__ Water Supply: Public system [3 Community system El Private Depth fi Water Table .0-_ ft, j Character of soil to a depth of 3 feet: Sand ❑ Gravel-❑ Sandy Loam❑ Clay Loam Clay❑ Adobe ' Hardpan [I Previous Application Made: Yes ❑ Noq?S., New Construction: Yes 0 Nox , TYPE OF INSTALLATION AND SPECIFICATIONS: ( P No se tic tank or vsspool permitted if public sewer is available within 200 feet.) tfa k: istance•from!�near est well__,'...::_....:.Distance-fromfoundation._...........�.._._.MateriaL_.._._................... ----- No. _ No, of comps meets...-- rr Size...... Liquid depth....------ -- ...Capacity---_-------........ t Dis oral Field: Distance frominearest well.,StO... Distance from foundation...--'- --` Distance to nearest E�},)iny�_. a...--. Number of liries._.....�...._... ...... . Length of each line..-fit- idth of trench....._. .... , „ _Total length--- .-Distance oT ii r, al: .Depth of filter materiaL._.�.. ........... g 7 .a _ d Seepage Pit: Distance to nearest well -------....:.......Distance from foundation...___..____.Y__...Distance to nearest lot line........_-..._._. Number of pits---------------------Lining material-_-----------_- ----.Size: Diameter........................Depth.- --_--.--------- ---------- .. Cesspool: Distance fio nearest well._______________Distance from foundation _._....... --__..Lining mat®rial_..__._.._.._. ._....__..__..._._.... sgals. ❑ Size: Diameter ........................... Depth '........ .__..._..................... Liquid Ca _ ti ::Distance from nearest building Privy: Distance from nearest well_...... ..::`(!+ •••------------- - - t Distance tori crest lot line._.'---- --------•=y....................'.......__:....-•----•--..'..._�---------•--•- Remodeling and/or repairing (d1cr1be) r# 4._..._._.. ._... __._..__._. ------_---- . . ..w ....................... II �. --•--•-•--...................................... - ._.._.. t I .. :l.. •. r:.. 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, anj rules and regulations of the San Joaquin Local Health District. Ilki ` ' .•••---:........(Owner and/or Contractor) yJ_ (Plot plan= showing size of lot, to ation of s stem" relation to walls, buildings, etc., ca be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.�'....._-....................... 1 DATE-----------------------• •...._.-.-_.--------------------- DATE-------��---._ .. ,•_,,.err-10.0 ... REVIEWED BY.. __._... DATE-------------•-------------------- 8U1LDlNG PERMIT ISSUED........It- :-------- - 1 Alterations and/or recommendations:.._:........ ----- - - I .....------•---•--•----••.... ............................. +s,! ,.. .„_ . ...................................................................... _ .................. A..,4 T'�•' i - Date................................1- .. FINAL INSPECTION -BY:_ :..... -:...------ --• - . SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 130 South American 5}reet' 132 Sycamore Street 814 North "C"Street Tra California Stockton, California- Lodi, California Manteca, California cy, ES___9-2M ' 145456 ATWOQO 12.54