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: APPLICATION FOR SANITATION PERMIT Permit No. _ 2..S_._ 0 0�Us�� , (Complete in Duplicate) Zf / > � Date Issued ___-- plication��ly made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This dpplicationQs-made in compliance with County Ordinance No. 549. JESS AND LQC �TION OB AD& ` --<e ��> — - , 122" 3 44f)3 -�------- '---------------- -------------------- -- honwners Name aela AA -----------------------�f"------------------------------------------------------ --------- ------------------ -€--------------------------•--------------------------------------_-. ContractorlsP Jame--•--•----------------••------------------- "' Phone--------------------------------- Instailation will serve: Residence Apartment House ❑�;LCommercial E] Trailer Court ❑_ Motel ❑ `Other El Number of living units: __Number of bedrooms __"Number of baths"_ ' - � x__` ------------------------------- Water 3 ._ r• ---- of size"`_-- ------- --- ---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table�-ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Ej Clay:M" Adobe ❑ Hardpang Previous Application Made: Yes ❑ ENo D( New Construction: Yes f& No ❑ FHA/VA: Yes : No ❑ �- _�TYPE,OF.;.1NSTALLATIOW:AND.:SPECII=ICATIONS: -t• ;�. • - € - - (No septic tankFor`cesspool permitted if public sewer is available within 290 fezT �.t Septic Tank: Distance from nearest well--.'7_ _______Distance rom foundation__________________.Maters I-------------------------------------- __.-_----- Nc. of compartments_-_-__. Z---______Size----______ _44xq-Liquid depth_______ "------ Capacity--__5 Disposal Field: Distance from nearest weil___7�------- .Distance from foundation Distance to neares#:lot Ie � ______ Number of lines_..-_.____3------- ---- d Length of each line- �j�__ '�:_ _____.Width of-trench___________ f___-___-`. Type of filter material_ r` te-_Depth of filter mafer,ia-__-_/s�_I_-__-_Total length_____________' Seepage Pit: Distance to nearest well_____-_-__._.__ Distance from foundation_____________-----„Distance to nearest lot line-------__________ [ ❑ Number of pits.-------- Lining material------------------------Size: Diameter-----------.----------Depth-.--------.---------------------- 1 Cesspool Distance from nearest well--------________Distance from foundation_____- ----. Lining material________ ___________________________ ❑ Size: Diameter----------------- ---------------------Depth- -------_ -------------- ------------ ------Liquid Capacity----------------------------ga S. Privy: Distance from nearest well--------------------_-__-___._____ _ .___.Distance from nearest building____________.__________________________._. r Distance to nearest lot line._.____--- -- 3 -------- Remodeling and/or repairing (describe) " -'' ! L� ----- ,..,, -rt•: -'-"«art-a # , ..• 4 -----------.------------- ' ----------------------------------- -- - ----- -- !j ' - ----- -- -------------------- -------------- --------------- ------------------------------------------------------------------------------------- ?` - =---- p---- ---------------------•---------------------------i----------------------------------- -----------""- ---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that'the work will be done in accordance with San Joaquin County ordinances, Sfi to a . , and rules an r ulatio of the Sa Joaquin Local Health District. i w y ` (Owner and/or Contractor i (Signed).. ----- ----- - T By`- = _ -------------------------------------------- ------------- (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc.; '+ac n be placed on reverse side).. -- -�.. ,"FOR DEPARTMENT USE ONLY t 1 DATE 1�� ° APPLICATION,ACCEPTED BY---=----0..( ,_ _- - - - -•--------------�=-----•---••-t-------------------- - --• - --- ---- -------------------------- REViEWEDBY---------------------------------- .I✓-- /E--i---- ----f- ------------------ DATE------ --- - ---------------------••-•------••----.------- �BULLDING,PI_RMIT:ISSUED-----•-•----------------------------------r--="------------------ -------------- --------------. DATE------------------------ Alteration s —nd f orrecommendations:----------- = - _ i e k If I 1 i !I -'---- -- -- --- � l - -- Date_ Z - ------- �` FINAL INSPECTION BY:A _. _ . . .- - ,� -- 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-7-2M , Revised 1.57 F,P.CO.