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No. ti APPLICATION FOR SANITATION PERMIT Permit ^(� A. �. (Complete in Duplicate) �* Dote Issued ----- -- --------- Application is hereby Dade to the San Joaquin Local Health District for a permit to construe=t and install the work herein described. This application is made in compliance with County Ordinance No. 549. �S JOB ADDRESS AND-:OCATION__-__ 33___.. = ----- {- -- Owner's Name--- , Ik'�= Wit° Phone Address_ ! I �...... ------ ---------- --- -- ----------------- ----------.... - --e contractor s Name. := D-4 �-zf it 4.-- Phone._ -_: __' 1rtR. Installafi'on will serve: Residence Apart ent;House ❑ Commercial ❑ Trailer Court '❑ Motel Other ❑ 1 ` Number of living units: _/__ Number of bedrooms ,_-�?_� Number of baths __Z__ Lo.Isize _�. �_ -_______________-____ Water'Supply: Public. ysdem` Community system ❑` Private ❑ Depth to Water ILI ;able ft. ChSra�Cter of soil to a depth of 3 feet: Sand El Gravel ❑k Sandy Loam ❑ Clay Loam 1:11 Clay F]. Adobe Hardpan ❑ revious Application M' dl Yes ❑ No New Construction: Yes No ❑ FHA%VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tankor'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_____________#-___.Material______--__________._________________..__________- No��I # p - ------Liquid depth-----------------------Capacity---------------- of'comartments--------------------------Size----------_--__------ Disposal eld: Distance frOM-nea est well�"`"""""'Dis"tance from found'afie'n=__"-`-`____.Distance to nearest lot line_________________ NA" ber of lines----------------------------------Length of each line------------------------------Width of trench----------------_-_-----_--------- Type of filter material------------------------Depth of filter material-----------------------Total length---------------------------°---___-------- NI r 11 Seepage Pit: Distance to nearest welL '_._�Distance from f ndation,l __ -____.Distan�e•to nearest lot line__-`___'�___ �N Number of pits_____.(____________Lining material ---Size: D}ameter____- �_______.Depth-------__�S__------------t ,I� s Cesspool: Distance from nearest well------------- .__Distance from foundation--------------------Lining material------------------------------------- (l� ❑ Siz p: Diameter----------- --------- -De th---------------------------------._.----------------Liquid Capacity----------------------------gals. Privy. Distance rom nearest well-_______________________________________________Distance from nearest-building__________.___.______-------------____._. �+\} i ❑ Distance to nearest lot line------------`"�;-r---------------------- ------------------------------------ ------------------------------------------------------- Remodeling and/or relit airing (describe):---* -- ------ --_-- �-- - ------- - --- ------ ---------------- � 1•,r✓ ----------------------------------- ---------------------------- -- ----------------------- ---- --- ------------- ---------------I-'- ..fir'"----------------------------------------------------------•--------I-----------------------------------------' - - ---------- ---------- ----- - ---------II�------------ ------------------------------ 4-------------------------------------------------------------------------------I----------------------------------------- 1 hereby certify thatFhhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S�tatte� laws I'and rules and regulations of a San oaquin Local Health District. E`--� 1 / 1 (Signed) '`"cam- i1c' (Owner ncf/or Contractor. -------- --- ----- ---- -� -------------------------------------------------(Title - - ------------- -------�`�------------------ � h� (Plot plan, showing siz ie'I of lot, !oc 1 n of system in relation to wells, buildings, etc., can be placed on r rse de}. FOR DEPARTMENT USE ONLY Y I APPLICATION ACCEPTED BY-------------------------------------- DATE r REVIEWED B ------------ i-------------------- ------ ------ - DATE -- _.L . .. - - -- -- ------------------•---------------------- BUILDING PERMIT ISSUED-_-------------------- - - � ✓ Alterationsand/or recommendafions:---- --- - ---- - - ---- -------------------------•-•-------------------------------------------------•------ --------------------------------------------- ------- -------------------------------------------- ----- ----------------------------------•--------- ---- ------ -------------- ---------- rr Ili.. .--- O ----------------------------- ------ ��-------- :� 41�,� ----- ---------- FINAL INSPECTION' BY------------- f Date-------- -------- '" � � SAN JOAQUIN LOCA EALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M , Revised 1-57 F.P.CO.