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(� APPLICATION FOR SANITATION PERMIT Permit No. ._.J '7 V V t (Complete in Duplicate) ll Date Issued ----- Application ---Application is hereby madei;Mo 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 - 0 nce o. 549 .�� " '�C X73 JOB ADDRESS AND LOC ATION --______ _ IV - Owner's Name---- - - _ --------- ---------------- -- -~ ----------------- Address..--_-- -7&------------- -------------------------------- Contractor's Name_f�7:_ _ -- - ------------------I--------- - -- -----------. Phone------------ •-----• ---- Installation will serve: Resideice [X, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑------------ Number of living units _1---- Number of bedrooms ---q-- Number of baths --3_-- Lot size ---A7_ Water Supply: Public system. ElCon mun'ity system ❑ -----,_Private 2 Depth to Water Table 5�fl_ ft. Character of soil to a depth cf 3 feet: Sand X Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Iles ❑ No R New Construction: Yes No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-�S- 7d_--.---Distancq from foundation---/4-----_--.Materia#---_�%4rrGe_ No. of c0`[1partments-- -- Size- - - Q ) S -----Liquid depth Ca pacify-,r•?- p fY- -- -- Disposal Field: Distance f tom nearest well__ .. Distance from foundation__/Q------ Distance to nearest lot line--,�--:------- PQNumber of lines------�-------------------J Length of each line----Qp---------------------width of french---.-,%.V-1�-- > Type of filter materia _ ii _-_pepth of filter material_-ly__________-Total length-f��_!_ ------------------------- Seepage Pit: Distance t l: nearest well--------------_---__-Distance-from foundation--------------------Distance to nearest lot line___-___._--___-__ ❑ Number of pits------------------- Lining material-____------------------Size: Diameter Depth ----------- Cesspool: Distance from nearest wel! "_ __--_ __Distance from foundation-------------------lining material--.------- �li ❑ Size: Diameter -- --- --- -------------- ! Depth------ ---- ----- ---------Liquid Capacity. __. gals. Privy: Distance f^Iom nearest well__---__--- _` -------------------------Distance from nearest building El Distance to nearest lot line_---____ �} (,describe)---------------------------------------------------------- Remodeling and/or repairing -•------ ------------------•--------------------------- -------------------------------- --------------------------------------- hereb certify that I have - " - - -------- ------------ ------ I Y prepared this application a d that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules ;and regulations of the S Joaquin Local Health District. Si ned - r (Signed)_ g ) � (Owner and/or Contractor) ---- gY=------------------------ -------------11 -•- Tale _____ (Plot plan, showing-size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ------------------ �- 4U FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYI _- ---------------------------------------------------------- DATE----��--��'•-- ~S` REVIEWED BY------------=-------------IIU---- -------- ------- q------------------------ --------------------------------- ----- ----- DATE----- ------------------------------ BUILDING PERMIT ISSUED------II•!-------------------- ----------------------- ------- ------------------------------ - --------- --------- DATE------------------- -------- - - ----------- Alterations and/or recommends ions:------_ - ----- -_ -------I-------------------------------- --------------------------------------------- --------------- -- ----------------------------------------------------- i ---•-•------------------ ----------- ------------------------ - -------------------------------------------- FINAL INSPECTION 8Y - . . ----------------------- Date----. -Q+- --' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-4-2M Revised 1-57 F.P,CO. M