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APPLICATION FOR SANITATION PERMIT Permit No. --`/ � T r�'{ �• � a� ----------------- (Complete in Duplicate) �/ _ ' G i s Date Issued _�l_.z9�s__7 App' ation 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 Ordinance No. 549. i JOB ADDRESS AND LOCATION,-------- �„` ------ � � ' Owner's Name_ ------•---------•-- q - -------------------------------------------- Phe '-�•4� ------------ -- ------ ------------ �e_� --------------- Name_-.---_. ------------------ Contractor's •---------•••--- tA• R� --------------- --- - Phone-40 ' + Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ ' Number of living units: - ---- Number of bedrooms -4--- Number of baths __/_--- Lot size _-_-_%1 -- ------ -p - �G- ! �S + Water Supply: Public system* Community system ❑ PrivateDepth to Water Table _140 ft Charac#er of soil to a depth of 3 feet: Sand El Gravel` ❑ Sandy Loam ❑ Clay Loam ❑ Clay j Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No,& FHA/VA: Yes ❑ ,1 No TYPE OF INSTALLATION AND SPECIFICATIONS: F] 5 jKlo septic tank or'cesspool permitted if public sewer is available within 200 feet.) ell nk: Distance from nearest well-----------------Distance from foundation-------------- -- --Material-------------- -------- ❑ No. of compartments--------- ----------- Size Liquid depth_ --------------Capacity-------------- Dis a field: Distance from nearest weli_4b-4b --_Distance from foundation----- -_ < (� _fes-___--_.Distance to nearest lot line_- -0 Number of lines------------J--------------------Length of each line---------f. _-!---r-------Width of french--- --- Type of filter material_--__ ----------------- p�l�__--Depth of filter material r► Total length- 1 --------------•------------ Seepage Pit: Distance to nearest well_----fl�-_ -- Distance,from foundation---_ --- /.d-- Distance to nearest lot line-_-- Ix Number of pits-------/--_-----__--Lining material____ �('�-.Size: Diameter-_-- � -----------Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------Size: Diameter------------- ----------- --------- Depth--------------------------- --------------------- - - - -- --------- ----Liquid CapacitY-------- --------- ---------gals. Privy: Distance from nearest�v�elL--_-._._---- __---- -----------------------------------Distance from nearest buiHin g V Distance to nearest lot•fine-___--_.._--__:---__ Remodeling and/or repairing (describe):__------ -- --------- r -- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, State la and rules and lations of the San Joaquin Local Health Disfricf. (Signed)_•-- --------- Ems/ ---- ------ ---------- _/_ itc By:----------------- �, (Owner and/or Contractor) --- - -------(Title)------- (Plot plan, showing size of lot, loca ion a system in relation wells, buildings, etc., can be placed on reverse side). -------- -------------- -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- -------- -------------------------------------------------- ------ DATE_.---------••---------�------- - REVIEWED BY------------------------------------ r --- ------- - -------�- - ---- -------- ------ ---- DATE--------- --•---- -•- BUILDING PERMIT ISSUED_ — > - --- ------------------------------------------------------- DATE Alterations and/or recommenda#ions:.__- ---__ -- --`-------------------------•----------- -- - ------- i7� c' - ---------------------------------------------------------- ------------------------------------------ � f 1=fNAL INSPECTION BY:. �.W�'--� .Y-------------- Date----- S JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" $fre8+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F-RCO.