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APPLICATION FOR SANITATION PERMIT Permit No. __A/ (Complete in Duplicate) Date Issued ti`Sn is hereb made to the San Joa ui inIrlso, Y q n Local Health DrstrEct for a permit to construct and instal[the work herein described. ap Iication is made.in compliance i �ydnty din e 549. JOB ADDRESS`AND°LOCATION---------- ----------------------------- - ---- ---- ----- QED----- Owner's Name----------1 �-----��--- - __ez , .----- -- - -- ----- -- ----------------------------------------------------------- P one------------------------------------ Address 3-3-3--v � lrsr ___._ __---------------------------------------------•-------------------------------•--------- Contractor's Name------------- ----�T ----------------------------------------------- ------------------------------------ Phone. ��-/ Installation will serve: Residence g-' partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/- Number of bedrooms _- __ Number of baths Lot size -_ _' Z4_�-------------------------- Water Supply: Public system 9��Ccommun'ity system ❑ Private ❑ Depth to Water Table 60-_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E---Hardpan ❑ Previous Application Made:I Yes ❑ No D�New Construction: Yes ❑ No [�4�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) #t' �ak: Distance from nearest well_______________Distance from foundation--------------------Material _____-_-______._________________ --- No. No. of compartments=--- --------- ---- 1Ze--------------------------------Liquid depth----------.----------------Capacity Disposal Field: Distance from nearest well! _Distance from foundation__/,cl------------Distance to nearest lot line- Number'[� " of lines_____- Length of each line__30_-_/_,S�____Width of french.___ ___-S_____-__ ----------------- ---------_-- le S`--------------"-"-- ------Type of filter materia _� 'Depth of filter Total length Seepage Pit: Distance to nearest weir � c� Distance m oundation__.�_d.�.. Distance to nearest lot line/$ [� Number of its__._ _-------- Linin material-Size: Diameter_33_�� --Depth._-__ __._ ___� � P g - - - d-.� ----------------- Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material__-._-----_--____.____.____________ ❑ Size: Di I amefer------------- ---------------------{Depth------------------------- -------- ------------Liquid Capacity----------------------------gals. Privy:❑ Distance stancfrom nearest well____________________________ ---------Distance from nearest building------------------------------------------ eto nearest lot line--------------------------------------------- - --------------------------------------------------------------------------------------------- I � � Remode6g and/or repairing (describe):----------------------------------- ----------•-••---------------------------•--------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------=-•------------------------------------------------------------------------------------ ---------------------------------------l--------•-------•----------------------------------------------------•------------------------------------------------------------------------------------------------------- - I hereby a fy!that I hav repared this application and'that the work will be done in accordance with San Joaquin Count ordinances, S a e air , d e and red ations the-San Joaquin Local Health District. (Signed) (O her and/or Contractor sy--------------------- ------ -- ------ - - -- ----- ------------------------ ---(Title) ----------------------------------------------------- (Plot plan, showing size of I , locatian of system in a ation to wells,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 5Y--------------------- ------------- --------------- ---------------------------------------- DATE---------------- REVIEWED BY = DATE---------- - � BUILDING PERMIT ISSUED------!_; �---------------------- ----- - --------------------------------------------------------- DATE.----------- \\\ ----------------------------------------- AI erations and/or recommendations:-------__----------------------------------------------------------------------------------- -------------------------------------------------------------- ---------------•----------••----------------------------------------------- ---- --- ----- -------------------------------------------------------------------------------------------------------------- ------- - - -------- -------------------------------- - ---------------------------------------------------------------- ---------------------------------- ------------------------------ -------- ------------------------------------------- FINAL INSPECTION BY---------------------------------------------------------------- Date------------------ ----------------------------- SAN JOAQUIN LOCAL 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-9-2M , Revised 1.57 F.P.CO.