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1Permit No. ------ APPLICATION FOR SANITATION PERMIT . '.'(Complete iri'Duplicate) Date Issued Application is hereby made to the SanlJoequi.n Local'Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549.' JOB ADDRESS AND OCATION-- / __� =` ------- ----------------------------------------- �� Owner's Name ►'. = ° ,....------------------------- P e ----- -- � Address--- _ f �h # - Contractor's Name--------`-- - --•- ----- r Phone,�l Installation will serve: Residence Apartment House ❑ Commercial E] Trailer ILat size Court El Motel❑//Other El Number of living iunits:l__-- Number of bedrooms !�1/__. Number-of baths r�--d -I`--r--d a ,� ... �.�..h Water Supply:' Public system Y Community system ❑," ❑ Private , Depth to Water Table L,� . Character of soil to a depth•of 3 fee+: Sand E] Gravel tl❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe " Hardpan ❑ Previous Application Made: Yes ❑ No New.Construction: Yes (] No FHA/VA: Yes 0 No C] TYPE OF INSTALLATION AND 5PEC1 ICATlONS o�'cess ool= ermi+ted if ublic se�e r is available within 200 feef':) t P P rte, - , _.,,I.: 1t p { p P y --Distanceundation__.J_ Material --- ---------------------- Septic - ----------31 �-- No septic tank y-- - - k , . Se ticTank: Distance compartments}- eal_ 1Ce , ��, � Ltiquid depth_-1-A------------Capacity__•-Q__-!l------ .11 - 11 ,��__'_'Distance to nearest lot line__.__-�.-___ Disposal Field: Distance from neares well__�/_ r.Distance from foundation____ ____ L+7 Number of lines------ -------------------------1-ength of each dine_-- -5,41-/•-----.Width'of french---v2- --- ----------------- Type of fi{ter material f_ d l{�_'_Depth of4ilter material___, ________-Total length---- ---------=----------- ' ....- . Seepage Pit: Distance to nearest well____________________-Distance from foundation____--__-___.._____.Distance to nearest lot line_.____-._____-___ ❑ Number of pits -Lining material---------------------- Size: Diameter----- -- --------------Depth------------------•-------------- Cesspool- Distance from nearest well------------------ from foundation----______----------Lining material----_________-_._______________-.___. \ ❑ - �F __ _ _ "'r Liquid Capacity - gals. Depth - : ---------- Privy. Dlista Diameter from nearest well -------------------- ---------------- V, t _- ------__:__'--.�Disfance from nearest buMinq------------------------------------------ Privy: L . _ _ Distance'to nearest lot line --= -- -- `- ._ --------------- ---------------- ,. 4 Remodeling and/or repairing (describe)------- -------------------- -------- q� ---------------•-------•------•------- --------------------••------•-----------• ------.... --------------------•------------------------------ *t -- ' -------•-------•------ i ilMi �1 -------------------------=--- --=---------------- -----•------------- -----------------------=;:_: ---------------------------------------------- ------------ Saui � I hereby ify that I have pre orad +his application and that the work will'be be done in accordance with San Joaquin County ordinances, St a aws, and rule nd r gulations of the�� n Jo urn Local Health District. {Si ned 9 ) 7 } weer and/or Contractor) ---------------------------------------- -5 -- - � "------- (rifle ,1 (Plot plan, showing size of lot, location of system in,rela tion to w , bu dings, etc., can bye placed on reverse side). FOR DEPARTMENT USE ONLY „ APPLICATION ACCEPTED BY--------------------------- ------ --_ DATE �1----------------------- �p �� DATE--- ----------4NI:r---- --------------------------------- REVIEWEDBY------------=---------------------------------------- - --- �- ------------_---------=----------- ----------------BUILDING PERMIT ISSUED-------------------------- --- �p----- ------------------- DATE. . Alterations and/or recommendations:---------------------- ----------'-----------------------------------------•---------------------- ---••- ------------------ --- -------------- R L,GI./�G Z 1 - � �; &3 e ----------- ----•-a�'�L' ' �'-------f"------------•------------ •------•--•- .;;FHl -------- , �. .. '' � y``: �,---------•------,3__7 7A---- Gro t,•-------------------------------------- -----------•------------------------ --- --------------------- ---------------- --C a----- 6 —a-AA ----_----=--� � Date--------- _�-�-.r�--~.� ------------=------------- FINAL INSPECTION BY::=---- --- - -------------•---- - SAN JOAQII`IN LOCAL HEALTH DISTRICT 4 130 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 , Revised 1.57 F-P.CO.