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APPLICATION FOR SANITATION PERMIT" Permit No. ._l_Il � -__ (Complete in Duplicate) XP Date Issued ---6 I Appt n lication is hereby made to the San Joaquin Local Health District for a permit to construci tall the work herein described. i This i((.application is. made in compliance.with Gounty Ordinance No. 544JO . E ADDRESS AND LOCATION__.0 - / fi _ ------ --- ---C'-- Owner s Name V la W_.S e --- -------' ---------- -------'--------------------- Phone-- -------------•--------------•---- Address---------------- -----------•-------_-- i Contractor's Name-----------------------•------_--•- r� - -------------- ------ ------- Phone-------------- F,� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ?' `� ❑ Motel ❑ Other �] Number of living units: _ __- Number of bedrooms ___-___ Number of baths ___'Lof size __.�_/ X C. aL. ----------------_--- Water Supply: Public system ❑ Communitysystem (� y ❑ Private� Depth Water Table _� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [:j Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r__,_.,�TYPE,OF INSTALLATION=AND SPECIFICATIONS:,, -; (No sepfic fank or`cesspool perrriiffed if public sewer islevailable wifhin 200 feet.) Septic Tank: Distance from nearest weiL,7;�---------Distance from foundation/d_--__.:'...__Material ------------------------------------------------ _X _ .-_ 2 ------ ----- No. of compartments------- _ --- '-----'-----Size_l�2�' -X Liquid depth__----.J =-------------Capacityd- d--- .� Disposal Field: Distance from nearest we4./5---------Distance from foundation_______________ __..Distance to nearest lot line_________________ ® Number of lines_____-__ ___ _____ ---Length of each line___--YU_____------ ti ,�p //,, Width of trench 1% --------- Type of filter mate rial___J-GC-�G/G._Depth of filter material___-_ __ 64 le- -----Total length-----1 � d -------------- -•- 5eepage Pit: Nu ante fo nearest well------------ -____-Distance from foundation_______________"__.Distance to nearest lot line___-__.____-___. ❑ Number of pits------''--------------Lining material_-------------------_-Size: Diameter----------------_----Depth----------------•------ Cesspool: Distance from nearest well_________________Distance from foundation _____-_________.Lining material-------------- El Size: Diameter---- ------------ ----- ------------Dep th----------------------------------------------------Liquid Capacity------------ --- - __gals. Privy: Distance from nearest well--__________________________ ---------Distance from nearest building = Distance to nearest lot line________________________________- Remodeling and/or repairing (describe)___________________________ - -------------------------------- ---------------------------------------------------------•--------------------------------------- -- ----- r - ---------------=r-----•----------------------- ----ere ---- t I - -• - re ---- --' --• ------•--_ ----•-----------------•-------------------------------------_--.-------- ---_--•------------------ 1,hereby certify that I e prepared this application and th # the work will be done in accordance with San Joaquin County ordi nce State laws, an ules a"d`regulations of the San Jo quip Local Health District. r (Signe _----.---- a ---- (Owner �By:- _-- and/or Contractor) . � - Y; --- ---------- ---------r----:-----:-------------------- - �..- � Or {Plot plan, showing size of lot, location 'of system in.relafion to wells, buildings, etc:, can beplacedon reverse side). EP TMENT SIE ONLY Y APPLICATION ACCEPTED BY----- __ _ __ - -- DATE_- REVIEWED ---�7------------------------- ----------------------- ----------------------- REVIEWED BY-------------=------------------ -------'-' •---------=- - _ BUILDING PERMIT ISSUED-----.--:- - - --- -------=--------- - DATE- = ------•----------------- ! ' ----------. DATE------_------------------------------------------------- _terations and/or recommendations----------------'------'-_----- - -- ------ r -------------------------•--------------------------------- ------------------------------- ------- - ----- - FINAL INSPECTION. -BY-------- C-X -----=--- -=------- - Date------ -----� - ------------'--------'-•--'-••----• 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 Traey, California ES---9-2M Revisea 1.57 F.P.co.