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FOR OFFICE JUSE.. (�-- ------ d- :APPLICATION FOR SANITATION PERMIT Permit No. ............ '...._ _--.-_ (Complete in Duplicate} ��/ ------------------------------------------- Date Issued ------------ -- 4 _--.; This Permit-Ex ires 1 Year From 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 ADDRESS AND LOCATION.___ `_0 > - -- -- -- -- ---------- 4 � r -----.-.- Phone---------••------------•----- Owner s Name----.- ..'� --•------ - - - --- - ------ --------•------------•----- - ••---- } ............... ----------------•-------••------------ ----------•---------- Address --------- Contractor's Name - �� -------•--------... ------ Phone-------- -------------_---------- ---------------------T�-(!: ----•------- 0-01 Installation will serve: Residence ❑ ° Apartment House ❑ ' Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "-"- Number of bedrooms Number of baths -;Z-• Lot-size y__A1A0Ze4tZ-------------------------------- Water Supply: Public.system [ICommunity system [IPrivate ❑ Depth to Water Table . Q ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ElSandy Loam ❑ Clay Loam El Clay E] Adobe 2"'Hardpan ❑ Previous Application Made: (If yes,date------- -------------) No New Construction: Yes �1N0 ❑ 1 HA/VA: Yes ❑ No [ ~ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer`is available within 200 feet.) r Septic Ta k: Distance from nearest well_-__'� Distanc f om foundation- ._Q . Mate`rial-_-(�-- _. p� f, - No. of compartments_------�.----`------Size-� - ' -- ---Liquid depth----"k----------.-Capacity----��- - Disposal Id: Distance from nearest well------- ----.Distance from foundation---I1.........Distance to nearest lot line---x------- i Number of lines------I-_-._---- ------ --"---�- Length of each line---- ----_._ -- Width of trench--A _--.------------------ Type of filter material--/ Q�Depth of filter material_--- ----_.-- _Total length----_- /----------------------!._ .� n. — Seepage Distance to nearest well----_---`--------Distance fr m foundation----/B-_.._-_.Distato nearest lot line--. ----_-.. Number of pits- ---- -----------Lining material- @.�_Size: Diameter.2,1Fnn�ce----.----Depth- ---------------- ------Distance from foundation..---------_-.----:Lining material.-..--------------------------------- Cesspool: Distance from nearest well--------- ❑ Size: Diameter-A----w------------' ------------- Depth--------------------------------------------------_Liquid Capacity----•-------------------_-gals. i . Privy: Distance from nearest we1L----------------t____-----------------------=--Distance from nearest.building--------------------------------.-------- . ❑ - Distance to nearest lot line Remodeling and/or repairing (describe):----------------- + I r t --- --•-----------------------------•---------- = -------------- -----------------------------------------•------------------- I hereby certify that l 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. �' Contractor) Si ned --� trac ort ( . -------------------------------- --- 1/ 1 gY=--------------------•-=------------•------��-----------•------•- ---- - Title--- - ----- -------- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can 6;-placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY------------------------ '� ! ---•-- ---------------. DATE REVIEWED BY '- ---- ! DATE BUILDINGPERMIT ISSUED--------- ---------- •- -- ----------------- -------------- DATE------------------------------------------------------------- Alterations and/or recommendations's_-=' .----=--__.:'=----- ---------------------------------------------------•- -----------------•----•--••-------- ------------.-------------------------------------- ---------- ---------------------------------------------------------------------------- -------•---------------•--------•-------------- ---------------------------- ------ --- --------------------- ------------------- ----------------------- ----- i FINAL INSPECTION BY:- " -. Date- a`t.l._4-- ------- k ' SAN JOAQUIN LOCAL HEALTH DISTRICT 4 ' fit. �, l 130 South American Street 300 West Oak Street, � �s., �-."�•I A Sycamore street: 1 205 West 9th Street Stockton,California lad],California ; Manteca,California Tracy,California �1 E8.9 REw�eCG e•99 F.P•tl 0.2M 6.6tl