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� f as Ism APPLICATION FOR SANITATION PERMIT Permit No. ___--------_---__--- ____ (Complete in Duplicate) Date Issued -5 �, ' "I� Applica+ion 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. 4 JOB ADDRESS AND LOCATION-------- 5'� -----•- --•�..---- T Owner's Name----------- �� 1��'� Phone Address--------------- ! ' ------------------------------------------------------------- -------------------------------------------•------------------•-----------------------------------------...__. Contractor's Name--"------------ ---------- ---------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial E]—Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number.of bedrooms Number of baths Lot size __7 _�x---7$77----------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table w-, r. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No w Vie, TYPE OF INSTALLATION AND SPECIFICATIONS: t� a (No sepyVic tank or cesspool permitted if public sewer is available within 200 feet.) a J9ptic a Distance from nearestwell" 7 ]i"stanncce from Foundation_ . ____.___Ma erip l w _ . ----w - "`; ------•---Liquid depth---- .- ---•--------Capacity.--��-_�_ . - rA No. of compartments.... ..;_ / Size- Fiefd isposal` : Distance from nearest wellP'.C.—D'�stance from foundation---!" ___.......Distance to nearest lot line- � Tel Number of filter. material f.�' _"- 'ergth of each line_______ """-----------Width of trench_____. �___________________ ,fp Yp J � Depth of filte'rI material----._1Y ---------Total length-----4-1 __°-----------------.-- ge Pit Distance to nearest well_.YW-W .-_Distance fro Frau at ion__��_....___.Dista rc�e to nearest lot line-AW_-__"-"_ l y /L Number of pi#s.__.._. .. `"`F_=Lin�ng�majerial��°(r �'E .. _.Size: Diameter----- --.--..._..Qeptn------ -------------------- Cesspool: Distance from nearest well---------- Distance from foundation-------------------.Lining material--------------------------- ------------ ---- :Depth --- ❑ Size: Diameter Depth------ ---------- -------------Liquid Capacity_---------------------------gals. "V privyE: Distande from nearest well_........_._.__ _________________ _ .Distance from nearest buildin ❑ Distance to nearest lot line-------------- _:_`..._- ---_ 9 Remodeling and/or repairing describe):----- v p 1 -- ----------- ` _ �_ `w - ----------------------- ----------- -------------------------------------------- ---------------_-- -------------- _- `' • f`'`ss1►c ------ ------------------------- ..... I hereby certify that I have prepared Ais,applicatian a d,that the work will be done in accordance with San Joaqu Co ty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � f)" -------------------------- --------------- ----------------- {� Contractor) (Signed)-----------------------/ - ----- B ' ---------------(Title)------ - -- -------------- a Y•- � * -------- (Plot plan, showing size�166�t, c on of system in relation to wells, buildings, etc., can be placed on revue�se sidd. ( FOR DEPARTMENT USE ONLY "4 k '; DATE----------- 4 APPLICATIONACCEPTED BY-------- •------ ,- - --- ---------------- ---------------------------------------- ------Z-f�-��--�- --------------- RI=VIEWED BY--------------------------------------------- -t `�� €--------------------------- DATE------------------------------- ----=---------------------- % BUILDING PERMIT ISSUED------------- ------------ - + DATE �M --------------------- ------------------------------------- ---- --------------------- Alterations and/or recommendations---- -----------w_-- -----------= " = ------------------------------------------------------------------------ --------•--- / - --- ---------------------•-••---•------------------------------.....--------------------- ------------ _.! �`.- _1 ------------------------------------------------------------------------------------ ._". _____________________ - .__ _ __..._______.._______..._..____._____ --------------.---------------------------------------------------_---------------------------- FINAL INSPECTION BY:.--- ------------------------------• Date....... -- ------------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Stroot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOD" 12-54