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APPLICATION FOR SANITATION PERM ` Permit (Complete in Duplicate) �!S a- - ,R - �j�/YIDate Issued 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 Ordinance No. 549. �j bed. JOB ADDRESS AND LOCATION___________ -__ aD Owner's Name--------------' _ - fes-=--------- ------ Address ----_ '�� 1-L- ----- --------------- -- Phone A dress..------•-----------�:_��?--------�'1`��y--�'H-�_tJ-•------------------•-- --------•-- Contractor's Name ---------------------- _ - -- nstallation will serve: Residence p Trailer --- Phone-----------•------- �� ❑ A- a�rtmentyHouse �]` Commercial +;p. ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _�_____ Number of bedrooms •_�_-'=Number of baths ___ ____ Wafer Supply: Publics stem 5 I t / Lot size ___'_//6S.CP----- g ' Y # ❑ Ccmmun'ity system ❑` Private �epth to Wafter Table _T� ft. �r� Character of soil to a depth of 3 feet: ,Sand ❑ !Gravel ❑ Sandy Loam ❑ Cla Previous Application Made:Yes, No" NY Loam El Clay ED Adobe 0-'Hardpan ❑ t ❑ ew Consfiruction: Yes @�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer'is"vailable within 200 feet.) Septic ank: Distance from nearest well-_/O IDista.ncerfro�m foundation_____-/Q--- __ No. of compartments_ _---_ --------- Size--- (- _- Material ------- --------------- Distance -- ------ Dispose l field: Distance from nearest well., .-__--_ Liquid depth----- _---_-_ Capacity___--FErQ-_ -- -G2___'DistallC$from f undation-__Z,4 Number of lines-__._-.--- -1 __- - ---------Distance to nearest loft line of each line`s_______ Q_�__ _V�idth of french-----:7 .• T Type'of filter material-__. - - _Depth of filter materia! /_ __'' A,,*� :,_ i --------Total length-------�D--�� — -------- Seeps 'e Pit: Distance to nearest well /A----- Distance from foundation__�/Q f-•.Dist v� e tp noares# lot IJ V l�lumb2r of pits---_-1--------------Lining material_,P�l�,___-Size: Diameter--- IF °�G Cesspool: -----------Depth_--._..c p Distance from.nearest well________________Distance from fouridafionmining material------------------------------------- - Size: Diameter_ 0_j ------------------ ! `� -- -- --------- ---- Qeptll. - -----:---- ..................Liquid Capacity gals_ " ----------- Privy" Distance from nearest weH--------- ----- I { Distance from nearest building lam► . El Distance to nearest lot,line_ • ,,.,. ---Dis g --------------------------------------- a.,. . - ------------•--•-------------------- - •ring describe):!!"----- ---------------------- escnbe):'I"�--:�� em��g anr�,fQ�. --='•---� - r. -.�I---- 1yr ----•--A-!-�r�1f.�_-_--- (� ` ..-� ------------------- t I ------•------ -- ------ - - _ # _ hereby certify fhat;i have prepared this a` 'lication and thA46 work will:be done in accordance with San Joaquin CounI pP ordinances, State laws;an� rules anq regulations r th San Joaquin Locel ealth District. (Signed}_-- -- ----------- - ----- - --- -(Owner and/or Contract gy:--------------- �=_ =._. -----I------------------t Z�,-- (Plof plan, showing sizejof�lot,,location of system in'rela'tion to wells, buildings;etc.,can 6e placed on reverse side-- a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY-7-7-1___.--:_ ---------- REVIEWED BY----- -------- p 4 DATE Y` BUILDING PERMIT ISSUED_ ------`----------- ------ € -DATE Alterations and/or recommendations#_____ ____ _ _ __ I `D �F --------------f______-__.__ ---__-____-_- ------ •-- I ---------------------- ------------- A t - = �� � ----- !r '.• � . _ "� L tJ 3- __ ------ --------------- ----- ----- F f-lam •-------- - , = -= � •� �- (�f FINAL INSPECTION 6Y:____..:-�___ � --------- ----- � .. Date----._.--'--------- � r� '- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California 7reey, California ES-9-2M Revised 1.57 F-P.CO.