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APPLICATION FOR SANITATION PERMIT Permit No. ��Ic (Complete in Duplicate) y 1 Date Issued ___--f ....7-f 7---f L Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal a work-here' described. This application is made in compliance with County Ordinance No. 549. d JOB ADDRESS AND LOCATION..---'- -- -- -------- -- -------------------------- -- !- „� Owner's Name----�,/ - P one. `�7 • � G Address------..��i_�__--• /1 '�'" Contractor's Name-------------------------------------------------------------------------------------------- ---- ---------------- Phone--------------- Installation will serve: Residence Jf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms ;"'---- Number of baths J------ Lot size ___ ____________________________•_------_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table.;7-Y ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy.'Loam ❑ Clay Loam 00 Clay ❑ Adobe E] Hardpan Previous Application Made: Yes ❑ No New Construction: Yes E] No X FHA/VA: Yes [❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) — Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ______-______----________-._____ No. of compartments------------ -------------Size--------------------------------Liquid depth-------------- -----------Capacity- E .___ Disposal Field: Distance from nearest well_________________Distance from foundation---------------------Distance 'to nearest lot line----------------- El Number of fines---------------------- ------------Length of each line------------------------------Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total" length------------------------------ ---------- Seepage - - Seepage Pit: Distance to nearest well_--_--- - m----Distance_ frog} foundn _ D meter_•�Jfan�e to nearest lotline__�~__ �_------ Number of pits-- --1-------------Li in aterial/1� _-- - Size: Diameter_ ---- Cesspool: Distance from nearest well-----------------Distance from foundation---------------.---:Lining material-------------------------------------- El Size. __________--..__-----______ - Size: Diameter-------------------------------------Depth------- --------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------__ _____------__ Distance from nearest building_--__.__---________-______ ❑ Distance to nearest lot line-------------- ----------------------------------- Remodeling and/or repairing (describe):-_----------------_------------------------------------------------------------ --------------- --- ------- --- --- -------------- ----------- - •A'd- ----- ------- Lam-�------------------ -- ------ ,,a4+r I here6 certify tha I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. Si ned , ( 9 )-------- - LU--- --------- Zion -------------------------------------------------------------------------(Owner and/or Contractor) f8Y= __ -- - --------------------------------------(Title)------------=--=------_-----------=-----=-------------- (Plot plan, showing size of lot, location of system in relto wells, buildings, etc., can be placed on reverse side). ~ FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY-__ ------------------------------ DATE_Op'47477 474 - -- REVIEWED BY---------------------------------------E-------------------------------------------•--------------------------------------._ DATE ------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- ------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------•----------------- --------------- -----------------------------•--------•-------------------- -- - -- - ---- ,. /.7-47- • FINAL INSPECTION BY:4:*/ ---------- ------------- Date �a__-`ell, - .. --------------- ------------- ---------------- •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.