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APPLICATION FOR SANITATION PERMIT Permit No. _4':7-f- -- T (Complete in Duplicate) Date Issued __��( . � _�1 - . 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 L ATION------ -�� -f-" �""�----------- Owner's Name------ --- ------a --------- �` -- ------- Phone .._._ Address-------- -------- �_ _,_,.I---------- - ----------------- Contractor's Nam, h- s l"+ -- �.''�"�.` � Phon ��, ce A artment House ❑ Commercial ❑ .Trailer Court ❑ , Motef ❑ Other ❑ Installation will serve. �Reside ��p •Number of living units: _/--_ Number of bedrooms._ Number of b th -"_ Lot size ---.- p ---"---X--.---� Water Supply:" Public''system ❑' _Commur6fy system ❑Private Depth to far Table Character of soil,to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ' i Previous Application Made: Yes ❑ No slew Cnstruction.`Yes - Na;❑ FHA/VA: Yes F1 No Lj--r 1 TYPE OF INSTALLATION AND SPECIFICATIONS:,/, F u. , .. - A(?septic tank Yor'.cesspool permitted if pubJJli••�c sewer is available.within 200 feet -e p ce from nearest�welCL.---'Distance from foundation-- / "-_"_--- _.Material--_-"-------- e - _,_ -- -.- --. ,/I Se tic Tank: Distance compartments- K_ _5 ----------- ---Liquid depth_.=_-" __ •__Capacity..--- No...I r I a /Q ` � • /�- Disposal Field: Distance from,nearest well-1�0_---._Distance from foundation-"-_--_"_--___-__"Distance to nearest I t l'n�fl Number of lines-----e)- -------�- ---11- Length of each line---49 __1----------Width of trench- -- -•--- -.-------•----------• Type of filter material ��f�_ Depth of filter 'Material__ t��______Total length--". _-p---------- -------- '";r --- a " #. , Seepage Pit: Distance to nearest:we -------------Distance from foundation- .-__-_.--..Distance to nearest lot line--._.--"----.-__ ❑ Number of pits-------------=------Lining material------------- `----- Size: Diameter------------------------Depth Cesspool: Distance ifi=om nearest well`------ ------Distance from foundation------------------- Lining material--------------------.-------------_--. ❑ Siie: Diameter------- ------------ Depth----------------------- ------------- --Liquid Capacity--------------- ---- gals. Privy: ;-DiiOance from nearest well-------------- ------------Distance from nearest building----.---------.--_-------------_------- nearest-lot --- ❑ .' - ----- ----- ----- ------ .. -~-Distance to nearest lot'line ARemodeling and/or repairing [desycyribe): __ f "'�""�" /- N-- "+r- - -------------------------------------------- y r►� !'C' ---- ----------------- -----'+"'f ---- ------ I hereby -----I4hereby certify that I have prepared this application and that the work will be done in.accordance with San,Joaquin County (ordinances, State la s nd regulations of the San-Joaquin cal Health District. an e ; f Owner-errd/,or-Contracfior) (Signed)_ --- -------------- --- ,{ -------------------------------------------------- -- -- .` - "�------------=-- -----=-(T le L it - rc ._ �.--=----•---------------- =---- -- ------ --=------------------------------ (Plot plan, showing size of lot, location ostein in relation to 741s, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATIOWACCEPTED BY ,< ---- -•-= - --------------------------------------- DATEx" - REVIEWEDBY-------------------------------- ----------------F�--------:-- :--------------------------------- DATE -. -- -ma BUILDING PERMIT ISSUED-----_ `--------- - DATE x --------- """"" Alterations and/or recommendations------------------------------------------------•----------- r "'" ....---.--- ----- ------ �`�-------- ------ ------------_------ ---------••-----------•--•------------------•-•------------- --------- •---- --------------.... -- ------- -- -- ------------------- ---------- -------------------------- --------------------------------------•---------•----- � ----------------------•---•---------- -------------------------------------------------------- ------ ------------------------------- FINAL#INSPECTION BY:_--- = - _:-"-- Date-------- -- if /c------------------------=----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California k ES-9-2M4 Revised 1-57 F.P.CO.