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y, e {Z� - _ - ,� APPLICATION FOR SANITATION PERMIT erm'� No. �s_�_r°..-�-- � (Complete in Duplicate) Date Issued _ -- --y Application,is hereby made to the San Joaquin Local Health District for a permit to construct and.i stall work herein described. This application is made in compliance with County Ordinance No. 549. 9 JOB ADDRESS A LOCATION_: _ __ �_ -_____ s _ / ---------- - _------ --- _ ,� _ Owner's Name-_-- -- Phone. _' _d- -/_---•--- Address � `' - - � �X-------- ---------------- ---- _..-. 67 Contractor's Name_- f ' � ff tri Phone_��__ Q Installation will serve: Residence Apartment House ❑ Commercial IX Trailer Court ❑ Motel ❑ Other ❑ fi Number of living units:Qy-41t.Number of bedrooms _�jjll oNumber of baths __ Lot size _ -_ - ---------------------- Water Supply: Public system Community system ElPrivate [IDepth to Water TableT�. ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [:1Clay Loam E] Clay [I Adobe Hardpan ❑ Previous Application Made: Yes 01 No New Construction: Yes x No E] TYPE OF INSTALLATION AND SPECIFICATIONS: �� 1 k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:' Distance from nearest well/}'LOY C. Disfance from foundation _10_____.Material__ f. No, of compartments- ------------------Size _= :5 i_ ---Liquid dePt`--- !---------Capacityf .a_O_ l� ,57 Disposal Field: Distance from nearest weli__/yt0yLQeDistance from foundation_ ----- ____Distance to nearest lot line_2�_=____- I. Number of fines__: .R....r_-- ------- Length of each line__ _- eE Width of #ranch__ _ '-------------------- Type of filter material_ IA"IQ�_�epth of filter material___:__ -------Total length.____ �______-_________f._.- __._.__.DI tante to nearest lot line_-.-_-__ Seepage Pit: Distance to nearest well---�F3ista ce f om�fo tion. 0 Number of pits-�\�"r-----Lining mate ial___ --Si e: Diameter__7--c--____-___-_.Depth a Cesspool: Distance from nearest well________________Dis nce from fou tion__________________.Lining material_______._____________---.----------.. s� ❑ . Size: Diameter. ------------Depth---•--------------------------------------------- Liquid Capacity ------gals. ' Privy: Distance from nearest well_-____________________________-----------------Dista nce from nearest building___________--.--________----_______.____.. ❑ Distance to nearest lot line----- ----------------------- =-------------- ---------------------------------------------------------------- F ' r Remodeling and/or repairing {describe):__ ----------- = ----------� � - ' h &---------- -------- V. .. �' - ¢ •----------•---------- •-------- • --------------------- ---- -------- I herebyof that I have re ared this a. is tion and that the work will be done in accordance with San Joaquin County ordinances, ta y s, and ru s end regulatio p of he San Joaquin Loc I Health ' trictz"` (Signed)---------- -------ID---- ---- -- F �- - (Owner a�n�or Con rac#or) • r1 . �- Ot�� --(Title)-------- - F `----------- By•--- ----------- �'- '�--•- (Plot plan, showing size of lot, location of s stem �n relation to lls buildin s etc., can be plat on reverse side). /y EP T - APPLICATION ACCEPTED BYc'= ---- - -Lt_I�la -� a—ve--expired_!N_It1D.Ut---------------- DAT L;✓_ :-------------------------------------------------- REVIEWED BY---------------------------- ,. li �OIT7fPt�' Cl 11Ptl DATE w BUILDING PERMIT ISSUED------------------ ---•- -------------------- DATE---------- Alterations and/or recommendations:__ ]y--��------ �CIli1G.- ( I_L [VI$Eflf�-_____________ 1 ------------------------------------------------------------------------------------------------------------- --- ----------------- ------------------------- ------------------------------------------------------- ----------------------------------------------- ------------------------------------------------------------•-•--------------'---------- i ------------------------------ -------------A-------------------------------------------------------- ------------------- FINAL INSPECTION BY: Y Date- *------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT M 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California. Lodi, California Manteca, California Tracy, California is ES-9-21M B-51 Revised W-2100 —St—