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v Vt No. - --- APPLICATION FOR SANITATION PERMIT Permi �-� ! — (Complete in Duplicate) Date ---Issued .__!_-j- -• Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work . erei eibcribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-401 t « �7 IF--•---=_ _f _ l./-------------= ------------- -----. Phone------------------------------------ _ ---------------------------- -------------------------- Name_______� - hlfC�, ------ /! _°' ------------ 49— Address , -r --- ' -----•-------- Contractor's Name---------- •- -- ---- -1T.�t�J-S-�---��..�'�?_--�---'�- _ '------------------ --------- - Phone. - ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ��-d�( � (�U Number of living units: ____ ___ Number of bedrooms -" Number of baths _______ Lot size ___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A!Cft. i Character of soil to a depthof3 feet: Sand Gravel ❑ Sandy Loam ❑ lay Loam ❑ Clay ❑ Ad be❑ Hardpan Made- Yes Nc New Construction: Yes)( FHA/VA: YesA N i Previous Application Mad. ., ❑ � lel TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or'ceisspool permitted if public sewer is available within 200 feet.) T ' _"---Distance from foundation_ _ Material____ 1tr��-----__.___-____._. Septi Tank: Distance from nearest well_ ��"""__""Ca aci fQ-�- No. of compartments----- _------ --------Size. ----'---- Liquid depth__�- .._- . P tY 1� f Disp s I Field: Distance from nearest well-f "0-----D stance from foundation!-iQ.__-"""--Distance to nearest lot line. Number,of lines-:---------3------------------ Length of each line,/00- .y-�Q__'CI�_�Width of trench---- 1� - i filter mafisrial____ ��<-Depth of filter material-_____f��"___Total length------ _ ----------------------- - t Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________---______ ❑ Numberof pits------- -------------Lining material-------------- --------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: ------------------------------- Cess ool: Distance from nearest well_______-________Distance from foundation--------------------Lining material---.______----___.___._- __----. pLi Liquid Capacity----------------------------gals. ❑ Size: Diameter---------------------------------------Depth----------------------------------------------------- 9 P Y---------------------- Priv Distance from nearest well-________________________ __________------------Distance from nearest building____---._________--___________--_________- 0 Y' gip: ------------------------------------------------------------------------------------------- El Distance to nearest lot line--------------------------------------------- ----- Remodeling and repairing (describe)---------------------------------------------- ------------------------------- ------ ------------------------------------------------------------------- i� --------------------------------------------- --•------------------------------------------------------------- ------------------------------------ -------�(----------------------------------•---- -•--------------- -------------------------------------------- ----------------------- -- ------------------------------------------------------------------------------------------ ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules.and re ions of the San Joaquin Local Health Distric+. 1� [� o ! - -_.__ Owner,and/or Contractor) --------------- (Signed) --- ��-- 1�--------------------------------- -- _- - ---- ---------- ( ) [Plot plan, showing size ofl;plo+, location of s stem in relation to Its, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--- �--------------------------------------------------------------- ----------- DATE----- 1 --------------------------S------------------- REVIEWED BY-------------------F------------------------- --------- DATE--------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE ----------------------------------------- Alterations and/or recommendations:---___.__.____..._____.___ ------------- ------ ------------------------- ------------------------------- -----------------------------------------------------••-------------------------------•---- ----- ---------------------------------- --------------- ------ - --------------------------------------- ----------------------------------------------------------- FINAL INSPECTION BY,:4_, ------------------- P,r-/ SAN JOAQUIN LOCAL HEALTH DISTRICT Oak Street 132 Sycamore Sfreet 814 North "C" Street 300 West Oa 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M , Revised 1.57 RP.CO. iI