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CApplication APPLICATION FOR SANITATION PERMIT Permit No. ._..[__;'____-_---_ .(Complete in Duplicate) Dots lssued ____is hereby made to the San Joaquin Local Health District for a per it to +fit and is II t e work herein described. pplication:is.made,in.compliance with Count Ordinance Nv. 549. f ADDRESS AND LOCATION = ---- -------------- r's Name � 1� � -- -Z�g Pons. -ss__ // �r 1 /¢q --------------------- - ".1--. _./__..:---I�uC-X--KC.X- ----- - lactor's Name----------------- ' " k �l P�le2l. --- = J(v r ._ a': Yhone --------------- C --------- - r t Installation will serve: Residence partmen At House ❑- Commercial❑ Trailer(Court 0 Motel,❑ Other ❑ Number of living units:-_L_____ Number of bedrooms Z--- Number of baths _ Lot size // 9__.______ Water Supply: Public system ElCommun'ity system E] Private Depth to WaterTable _-67-- ft. if Character of soil to a depth of 3 feet: Sand Gravel El "Sandy Loam E] Clay Loam❑ Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes.E] No New Construction: Yes � ❑ FHA/VA: Yes ❑ No ❑ TYPE,.OF.INSTALLATION AND SPECIFICATIONS: (No septic taW-Sr eesspool-permitted if,-pu6lic sewer.is available within 200 feet.) Septic Tank: Distance from nearest.wells 02-9'^Distance from fa tion_ d? `^"'ivlataria No-.'of compartments__ ____�� __-_- �5ize_ ��_ _ _ `�__,___Liquid depth.... .__ __ Capacity___/ - r r-� Disposal Field: Distance from nearest well_ -y"`_Distance from foundation_'51__ ___..Dista 1 e to nearest lo`tt l ne__�_ Number of lines--------�--------- ----- ength of each line------ -------��-.---Wid±h of trench_�� -- --------------_----{� Type of filter material------52� epth of filter materiel____. _________Total 'length`___l_5__0_______________________Q Seepage Pit: Distance to nearest well----------------------D'sstance•from ---/Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material-----------------------S!ze: Diameter------ .._-Depth-------------_.________---------• Cesspool: Distance from nearest well_______________Distance from foundation:___--- -----_.__..Lining material__________________________________ ❑ Size: Diameter------ ---------- -------------------Depth--------------------------=------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------7777777= "�`Distance from nearest building__________________________________________ ❑ Distance to nearest lot-fine-' - = ------- ---- --=------------ --------- ----------------- S s Remodeling and/or repairing {describe}=:-- •--- --- ---------:-- "�` � --'------._.- - �- r -------------------------------------=--.----:------------------------------------=--------------------=-----------------------------••--- ------------------------I------------------------ ------------•-.----- -----=--------------------------------------------------------------------------------------------------------------------- -- ------ ---------------=--------------------------- -----•------------------ ----------------------------- - •--- I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, State laws, and rules and regulations of the'San Joaquin Local Health District. l (Signed)---- ..r:;`w""-- -------- - ---------------------------------- ( or Contractors By:---------- - ----------- --------------------------- -- - -- ---- --- --------- (Title) ------------ I (Plot plan, showing size of lot,`�location of sysfem in�:relafion'to'wells ,buildings, etc.,scanrbe;p.ac d,on revers, a side),.__ FORD NT E ONL APPLICATION ACCEPTED BY ` , ------ ATE---- r� �� -------------- REVIEWEDBY-------------------------------- - a ----------- DATE---•------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------- ----------------------------------------- --• DATE----------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------------------4 t -------------------------- = ----••-------------------------•-------------•----------------------------------••----------------------------------------•--••--------------------•-•-------------------------------- ---------------------------------------------------------•--------=---------------------------- -----------------------•------------------------•-•-•-------------• --•---•-----------------•----------=--------------------- a I. -------------------------------------- ' -- ---- - --------- -- -- ' FINAL INSPECTION BY:------- = `--------yv _ Date---------- � _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES--9-21A . Revised 1•57 F.P.CO. r r�