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—T APPLICATION FOR SANITATION PERMIT66 Parmit No. (Complete in Duplicate) Date Issued . - /30-S 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 Ordina ce o. 549. JOB ADDRESS AND CATION --------------- ------- Owner's Name- -•- ----- ' --- --- ---" �.. ---------------- ---------------------- Phon ..� - ;------- Contractor's Name__-:__.�------------- ----- Phone- .-.... .. Installation will serve: Residence 9Xpartment House ❑I Commercial ❑ Trailer Court [l Motel ❑ Other f Number of living units: _�-.- Number of bedrooms --?-. Number of baths _ -- Lot size f" Water Supply: Public s stem �1� ------------------ y ❑ Commun'ity system ❑ Private p�lsepth to Water Tables§- {f. �4, -,, t ' .,. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe [Eollardpan ❑ Previous Application Made: Yes ❑ No [N---I<lew Construction: Yes ❑ No �IA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) S ti ank: Distance from nearest well-------------_--Distance from foundation---_:----- No. of compartments-- Size_, _ Liquid depth-------- ------------------Capacity ------------- Distance from nearest well e Distance from foundatpi n-._ - ---.--Distance to nearest lot line_--_---_-_•, Number of lines---.-f_-_-_---- Length of each line--_6A----------------- s, - - - -W�dth of trench.---,�--�/----- --------- Type of filter nateriaf �-- -� Depth of filter material_--_��-- - � ` ---Total length------�-�---•-------• --�^-- Distance to nearest well--_ --_ -v r I • ---__-Distanc om f undation_-_1310._--___.Dis cp�to nearest iot line-(� _ Number of pits}-----I--.------_--Lining material--YR-0 Diameter____- l-1 r � ------ -..Depth---- �--------- - Cesspool: Distance from nearest well---------------- Distance from foundation--------------.---- Lining material-----.-----------------❑ Size: Diameter_ ;----------- Depth -------------------------- ................Liquid Capacity----------------------------gals. \ Privy: Distance fromearest well-----------------------_-------__.--.-----___.-Distance from nearest building \ 11 Distance to nearest lot line__--_--�:--,---: -------------- Q -------------------- ------------------------- Remodeling and/or repairing (describe)--------------_--- ` w•----- ----------------------------------------------•-•------------------------------------------------------------------ --------------------------•---• ----------------- -----•-----•------------------------------- ---------•-----------•---•------•---•---••------------ 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couhty ordinances,B laws, and r les an egulations of the San Joaquin Local Health District. (Signed)--------- •-•--------- ---- ------- --------------------------- -------=--------------------------- caner and/or Contractor) BY: - -x- 1-1------- -��- - (Title)-----j��----- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ----- - ti FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ----------------- ---------------------------- ----------------•----------------------- DATE_-�- REVIEWED BY.----------------------------- ----------- - - - -- �--- ----------- - - DATE----- -•-------------.:.---- BUILDING PERMIT ISSUED------------- 11". -- ---------------------------- i1 Alterations and/or recommendations: DA ------------------------------------ -- E -------------------------------------------------- Alterations -------•----- -- '-- -- ---- �--------�-��s------�c�---��Y�s-.��x--� �.7-��-�---��- �.�----�-,�-rte:---•-- �..G --------•--------- ` --'5---------- QC -- -L.k� eb/-7°..----Ala-----.6�aA ,W$ --- ----------- ' fpr /1/d -01SP5/,0s+01 40Xid ar r --------- NAL INSPECTION BY:._i ,; ,4-.r•--Y:--- /4 Date ------ ----------- --------------------------------- SAN JOAQ LO L HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M , ReyisOu 1.57 F.P.CO. r F }