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APPLICATION FOR SANITATION PERMITPermit.No. __ _t° ------ (Complete in Duplicate) —T - P__ s 3 r 0/ — Date 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. JOB ADDRESS AND LOCATION----I.7- __--_-- ---------------------------- G��RoN•�GL ____- Owner's Name v_ T --------T ' --ri:. — Phone------------------------------------ --- � �'�----------- Avi 11_c�------------ &-----------------------------------------�--------------------------------------- Address----------�----- CH •................ ' Contractor's Name ='- - --------------------------------------------------------f--------- Phone----------•-----------••------ ,I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑j Motel ❑ Other ❑ Number of living units: )------ Number ofi bedrooms __ ___ Number of baths -1_--__ Lot size _ �Q---,�__f_10Q------------------------------ y - _ _ Water Supply: Public system ❑ Community system ❑ :: Private ❑ Depth to Water Table _1______ ft. Character of soil to a depth of 3 feet: Sand U Gravel 0 Sandy Loam ❑ C€ay Loam ❑ Llay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well NON95__Distance fr mzfoundation-----rQ----------Materi�il------R> D_W Op______________ SiNo. of compartments------- ze ---=--- Liquid depth-------�-- ------Capacity-----9-0 45A_4— Disppoossal Feld: Distance from nearest well_________________Distance from foundation--------------------Di stance to nearest lot line----------------- 1 Number of lines----------------- ----------------Length of each line------------------------------Width of trench-------:------------------------ Type of filter material______I_____.______.__De'pth offilte material_-_ ----------Totallength------------------------------------------ __ T 1 Y Seepage Pit: Distance to nearest well___ ______________ sta __Dince--�fro'moundation _ ________.Distance to nearest lot line_______________ ❑ Number of pits- -----------I--Lining mafdriall---------------------Size: Diameter---------- Depth-------------------------------- i a \ Cesspool: Distance from nearest Bell_________________Distance from foundation. ____-__-_-______.Lining material____-.---_-----..__-__-____-________- Size: Diameter o Liq id Capacity gals. ❑ De. th ----------- - ----- ---- Privy: Distance from nearest wel__ _____________ _ ___________________._Distance from nearest building------------------------------------------ Distance ____-______-._- -____- _ _� r ❑ Distance to nearest lot lire-------------------I------------------------- ----------------=------ ------------ --------------------------------•---------------- ---- Remodeling and/or repairing (describe):-------�'__s�---- -- �> ----------------------------------- -----------------------------------=-------------------------------- ' ' ' - F ---- _- _-------------- c____________________________________________________________________________ ____________________4______a________.____________-____________M__-_______-____ __-___---___.___________-____-__-___________________._ ----------------------------------------------------------------------------- -------------� _V-------- =� E'c `e---------------------------------- ---- --------- I hereby certify that I have prepared thislapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local He' alth District. (Signed) ---------� --•-=------------------------------------------------------------------(Owner and/or Contractor) --•--•-----------------------------------•-•------------- = BY' ----------(Title)---- ---------------=-=--------- -------------------------- (Plot plan, showing size of lot, location of system in relatioWto weld lss,buildings,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY - ---------------------------------------------------------- DATE--- = --/0--- REVIEWEDBY---------------------------------------------------- --------------- °' DATE-- BUILDING PERMIT ISSUED ---------- --------------------------------------------------------- DATE---- Alterations and/or recommendations:__-__________ _________________ "'" ' --- � -•--------------------------------------------------• ------------- � -�'�_4M,�=_'x�►�-�--------- --r+e'^9 ;F- ---------•--------------•----_--------------------------------------- 1— -- --------- --------------------------------------------------------I----------------------------------------------- zft-FINAL INSPECTI BY:------- --- -- - -------- SAN - JOAQUIN 'LOCAL HEALTH DISTRICT i 130 South American Street 300 Wes* Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.