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X2 - APPLICATION FOR SANITATION PERMIT Permit No. --7-a- (Complete in Duplicate) Date Issued ------- r � 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 comp i1. n w f ounfy dinanc No. 549. TZ Ae VoTt� �F ---------------- JOB ADDRESS A?9 LOCATION --w }----- --- --- -0 j-- -7 1 4 one--------------rjZ_A� - Owner's Name---- _k-------- -- -------- -- ---------- ----------------------------------------- -------------------------------------- Ph Address-------` A -------- ----------- -------------1-----------------------------------------------r----------------------------------------------- --2, ---- Contractor's Name--- ------ -------- ---- - -- - - ----------- -- -------------------------------------------------------------- Phone----•--•-------------------------- Installation will serve: Residence � Apartment House E] Commercial 0 Trailer Court ❑ Motel ❑ Other 0 Number of living units: -]---- Number of bedrooms -3-- -- Number of baths JL Lot size, ----------------------- Water Supply: Public system D Community system F-1 Private 9 Depth to Water Table __�o �t. Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy Loam [:] Clay Loam E] .Clay [] Adobe W Hardpan El Previous Application Made: Yes E] No X, New Construction: Yes XL No E] FHA/VA: Yes E] No 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---t�b-----Distance from foundation-------jo------Material__'_2&�------------------------------• No. -- -------I------------------ No. of compartments---as----------------size--------------------------------Liquid depth--------------------------Capacity----------------------- (3 f tline__,__.____ Disposal Field: Distance from nearest well_t��_D------Distance from foundation___1_Q___-------Distance o nearest lot, Number of -- --------Length of each line-160 ---Width of trench------a--------------------------- Type of filter mater' ---- ----Depth of filter mater-,--- ------------- n -------1_��------------------------- al- -Total le'gfh V)1i Seepage Pit: Distance to nearest.well__'_%M---------l3istancpo om foundation_____&)_( Di6tancq to nearest lot liye---t�--------- Number of pits-----*7#--—---------L ining material_ size Diarnefer-4-9k-6----------Depth-------&---------------------- ---- Cesspool: Distance from nearest well________________Distance from foundation___._________- .---.Lining material-:----------_______._-______________ ❑ aterial------ ------------------------------ ElSize: Diamefer--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____ --- ------------ ---------------------Distance from nearest building__________._--_________________________-- -e---------- ❑ - - Distanceto nearest lot line---------------------------------------------- ------------------------ ------------ --------------------------------------------------------- Remodelingand/or repairing (describe):--------- ----- ---------------------------------------------------------------------------------I------------------------------------------------------ ------------------------------- --------------------------------------------------------------------------------I——------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to lawfanq rua and regulations the San Joaquin-Local Health District. (Signed)------- AM ,W -----------------------------------------------------------------(Owner and/or Contractobx ---------------------A 401V 42�------------- By:---------------------------------------------------------------------------------------------------------------------------------(Tif le)------------------------------------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---- ------- ------------------------------------------ DATE---- 4,90--------------------------- -------- - ---- --- ---------- REVIEWEDBY---------------------------------------------------0- A-/_---J------- --- ------------------------------------------ DATE------ -------------------------------------------- BUILDING PERMIT ISSUED---------------------`.------ ......r ---------------------—-------------I------------------------ DATE--------------------------- --------------------------- Alterations and/or,,cfomme: Pions:- ---------------e.-------(�--------------------------------------------------------------------i ------------------------ ------------------------------ ------------------------------------------------------------------- b. 713 ---------- ------------------------------------------------------------------------- --------------------------------------- ----- ----- - ----- - -- -- ------ ---- --- - -- FINAL INSPECTION BY:.jSZj(W 'Date-...- -- - ------------ -------- ----6- ----- - ------------------------------------ X//-�aI6 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 Revisea 1-57 F.P.CO,