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Pik APPLICATION FOR S i ANITATION PERMIT Permit No. ___`.�_•2_ 4 (Complete in Duplicate) 0 Dateued lss � --E_ --• _ 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 compliance with County Ordinan e No..549. J�df 41 J JOB ADDRESS AND LOCATION_74 _ k -� r Owner's Name___-,/-_- _ _ .. Address ----- - •----- x --------- Pone_ Contractor's Name--- ---- f p - ----------------------------- Phone__42_ -_Q� Insfallation will serve: , Residence FA K_ pertmenf Hou`se,❑�=Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: _ _ Number of bedrooms--Z"Number of baths Imo_ Lof size ___"__7,! - - 9 -------- Water-Supply: Public system 12KC.jm,mIunity system'❑ -Private ❑ -Depth to Water Table (7ft.• -x Character of soil to a depth of 3 fee+i" 5a'nd ❑.. Gravel F1 r Sandy Loam [] Clay Loam ❑ Clay 1 € r y ❑ Adobe ardpan E]Previous Application Made::;Yes El No New Construc,4 : Yesy❑ No ❑ FHA/VA; Yes [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- , No septic tank-or`cesspool permitted if public sewer i veilable with n 200 fee+.) £ ` ' T nk/ a Distanceo �from nearest -welf---_____- _ --Distan Distance from fooundation___� -_•,Material--------------- S' _r y compartment' ize-------------------1-•--------- -- -- Liquid depth:-- Capacity N?. 4 ' Di sal Distance from nearest=well____-_.__- .-�-Distance from foundation---_________________Distance to nearest lot line_____:_-___._____ Number of lines----------------------------- --i_Length,;af each'`line-____-`-'-------------__--�.Wldfh of trench ---------•---------------- --- ----- Type of filter material�- ~-------}-Depth of filter material----•---------------'-Total length------ •-------------- --------------- ri L _ / r Distance to nearest wefl�-Ngi�,'-Disfance.f a fou dation. {- °A:.Distance to nearest lot line---- o - r �'a Number of pits------ -------------Lining material. Size:' Diameter__ ��----.Depth___)_X-�•-------------- Cesspool: ---- ----_ N eepage i Cesspool: Distance from nearest well--------------- foundation_�`^__"-�--i Lining materiaf_______.____.______________-______. ❑ Size: Diameter . =r --_- --------Depth__ — _" _--:__.-Distance from nearest building ---- ---- ---- ------- Distance to nearest lot line_ ^ ---- » '-._ «_.-- =_ . __`- .. -- ------------------ --------- :.._ ----- ---------------- ---------------=------- Remodeling and/or repairkng (describe] --.____ --{ . t .' fi _ f - --------------_----------__------_------__----------------------------------------------------- ---------- -------------.-------._____-__-__- __-__-______ j I hereby rfifry th + I have.prepared this ication and.that the work will be done in accordance,with San Joaquin County ordinances, 5t to laws, nd rules an r a ns of the San oa in Local Health District. -4: fr T (Signed)------------- ----t r , � .. -------- � - rac or Y- = === - ---------= Title n { : (Plot plan, showing size of lo+,�location`of system in relation +o• rs, buildings, efc, can be placed on reverse side). - 4 °j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__- -______ ---- = _ = ----_--------------------- 'DA REVIEWED ED BY-=- --------------------------------------------- --- -- DATE------------•----- • •- BUILDING PERMIT ISSUED--------------------"- --- DATE__ Alterations and/or recommendations__________ --------------------------- -----' -- ------•------------------------- --•-------------- �' - X11"'---�ra�� .�C-�_�� . �---•_!✓_.rJ_�:_../��-Sr�,�-�.-=---- � � .----------- _ _- 3 ' rTIl-4h 7 r 1. ' = , '.__.._. 5 • A-W- --- _____,� FINAL INSPECTION BY:: -F ="��'f-�•.f :-- =' Date_- /D__ _ _` F USAN 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 7.57 FRCO.