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'N APPLICATION FOR SANITATION PERMIT Permit No. __��_1 i ��1`'� (Complete in Duplicate) i� U� .. 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 LO TION:_ Owner's Name----- CAR !_!----- ---------------------- Phone------------------------------------ Address------- r_s.P------- -^ P,r Contractor's Name---; 1 ----------------------------------------------------------------------------------- P h o n Wa-(tr .�f 0.7_------- Installation will serve: Residence Department House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -/--_ Number of baths __/__ Lot size ----- �__,?t- _�_Q-----------------• Water Supply: Public system ❑ Community system ❑ Private 9+"6epth to Water Table lot-0- ft. Character of soil to a depth of 3 feet:,Sarid'❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U?O'Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes EP-11-o—EE] FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic TT k: Distance from nearest well__�7_, _Distance from foundation__-�-0--�_.--.Material_- -----------i_ _ R-1.1- No. of com artments...____-__[?�__---_---Size-�v ___ J p - - -�v�E.--�--Liquid depth----�-�--11'--�--------Capacity----�.Q11-�--- , Disposal Field: Distance from nearest well-.—SV. --- Distance from foundation---/fP---------Distance to nearest lot line____-_.-- Number of lines-----------tR_____ Length of each lin,ZC2__ ---- of french......._.�_�_��--_-_-.--- Type of filter materiaf__.��;_ __ p "' g Depth of filter material length e��_--______"__.______- Seepage FT Distance to nearest well--/"-- Distance m f undation_ZO-_-----__.Distance to nearest lot line---4._._-_...._ ETO Number of pits.--__-P---------__Lining material___I _-Size: Diameter-------3,3-_'�-__Depth-_______�--.-------------- Cesspool. Distance from nearest well--_._--_-- Distance from foundation--------------------Lining material---------------.__------._._-_---.- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. \ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building _------------------. ---------- ----- ------------------- ------------------- ❑ Distance to nearest lot line----•--------------------------------------- ---- -- - -- ------ -- - Remodelingand/or repairing jclescribe)---------- -------------------------- ---------------------------------------------------- -------------------------------•----------I---------- ------- •--- ------ --•------- ----=-------------------------------------------------- ------------------ ---------------------*- Y T ------- �' iv v • -------------- ----------------------------- j t ----=�--//3_�-D '@L1� cS S_ taJ iil/�iGPf�Tits7 �r�Pftn�si_0_�1__ �- --------------------------------- -- ---------------------------------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sts a ws, and rules and q regulations of the San Joaquin Local Health District. Si ned - ---------------------------------------------------------------------------(Owner ------ Owner and/or Contractor) T—1 By:._...-. 1/V_ Title - ------------- { )--- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- DATE REVIEWED BY - -----------------------------------------------/k?� DATE--------- ----VBUILDING PERMIT ISSUED----------------------------------------- ------ --------------------------------- DATE Alteratio and/or recommendations:--------=------ --------------------------------------------------------------------------------------•------------------------------------------------------ �Y ---------------------------------------------------------------- ii l7 s � r si ' .-- - ----------- -- -- ---------------------------------------------------------------------------------------------------------- - , -------------------------------------------- ------ ----------------------------------------------------- ------------------------------- -------------------------------- FINAL - FINALINSPECTION BY----------------------------------------------------------------- Date--------------------- ------T------------ --- - ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revises 157 F.P.CO. --�