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APermit No. _-A-AA-1......... APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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 LOCATION------------Z�7.�_ ------ ------------------- -------------------------------------------------- 7_ Owner's Name------ -------A4-404—in ----------- ........--------------------------------- Phone-)w---;C7---------------------- Address---------- ------- A- &V------------------ -------------------------- 7---------------------- ,J Contractor's Name---- Installation ame----- Installation will serve: Residence kr Apartment Hou5e E] Commercial [] Trailer Court 0 Motel L] Other Ll Number of living units: I____ Number of bedrooms 2, Number of baths -1---- Lot size ------------------------- Water Supply: Public systemCommunity system El Private E] Depth to Wafer Table Z/ f. ;kr 0 Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam [] Clay [] Adobe Hardpan F] Previous Application Made: Yes E] No New Construction: Yes 0 No x FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECI F XCATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) C/F istance-from foundation--- _ SeRf i ank. Distance from nearest we1_1_0----- _X"/ __.__ Materiaf----?,e ne! -------------- No. of compartments-------Z------------S-170--.1 ----- Liquid depth------_V_Z.. .......Capacity---4F-0-101,41 Di Field: Distance from nearest well_,,;�---�*�stance from foundafion___1__0__ ----Distance to nearest lot line_,__________ Number ine-=:5- ------ Number of lines----------Z?---- --------------Length of each of trench_.___. ---—---------- Type of filter material_-___ -Depth of filter material_____ length-------170 --------------------- Sev)4 e Pit: Distance to nearest well_ I.__Distance f�s4n founclafion—O.- Size: Diarneter----- .- ---------- -------Distance to nearest lot - –"--*, Number of pifs---- ------------Lining material----12_46G . Cesspool- Distance from nearest well-----------------Distance from founclatior--------------------Lining material-------------------------------------- ❑ Size: Diameter----------------- ------:------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--'---------;-------------------- - ,-:--I--------------Distance from nearest building_____._.__.____________________________- ❑ Distance to nearest lot line------------ ---------------------- ------- - ---------------------------------------------------------------------------------------------- Remodeling -and/or repairin (describe -3,6 ---------LjA_V--- -- -------- ------- --------- __ .11 --- - - --- ------- - -------- - -- - --- -- - --- ---- - ------- ---------- - ------- - ---- ----- ----- ---------- --- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ----------- - ----------------------------------------------------------------------------------------------------------------- ----------------- --- State la and rules ra ulafions of the San Joaquin Local Health District. (Signed)-------------- -- -- ---- --- ----- -- ------ ------<=�_ -______{Owner and/or ContractorL ) a Z7 _> By:-------------------------------------------------------------------------- ------------------(Title)---- �7 ------ (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -------------------------------------- DATE--------- ---------- -------------------------------- REVIEWED BY------------------------------- ------------------------------------------------ DATE----- . ... ................................... . BUILDINGPERMIT ISSUED---------------------- ---------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------- ----------------------------------------- ----------------------------------------------------------------------------------------------------- ------------_-------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ----------- -------------------------- ---------------- ---------------------------------------------------------------•------ ----------------------------- ------ - ------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--------------- ----------------------------- ------------ Date------- -------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod-L California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO.