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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued --- , This Permit Expires I Year From Date issued Disfirict for a permi const t install th work herein described. Application is hereby made to the San Joaquin Local Health , This a lication is made in compliance with County Ordinance No. 549. PP r -- -- - - T -------------- --------------------- JOB _,� '. :i �` J013 ADDRESS AND LO ON---- e " ---'---------- phone.----�---•��---- --------- ------•--------------•---- Owner's Name--------- ---- -------- Ft_�L- --•----• --- --1- - ------�'------ ------- -- QS`, ----------------------- -_.. -1------- Address------------------------- Phone----------------------------------- Contractor's Name---------- +! --------------------------------------------------- ------------------- r Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel [I mer ❑ ., ------------ Number of living units: __ ._. Number of bedrooms -- Number of baths --�-- Lot sae _.`_ -Q_'r-•T�-•--• Water Su l Public system Communit s stem ❑ Private ❑ Depth to Water Tab— -___---- ft. Supply: y Y Clay Adobe©,Hardpan ❑ Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y No KI New Construction: Yes & No ❑ EHA/VA: Yes ❑ jj No Previous Application Made: Yes [3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p is sewer is available within 200 feet.) I x —< Septic Tank: Distance from nearest well _-_. -_. _Distance fro�foundation_._ Q___..---.Mate� l_. --- - -- Li uid deptht-�--------------- CapacEty---- No. of compartments_._.--~--_--( - ----Size- == --------- q Disposal Field: Distance from nearest well----Distance from foundato /Q_ __ __Distance to nearest lot l e------ --.--- - -�Y -= _-- �- Width of french- . -- ----____--Leri fih of each line-_._--- - - � ----------- Type � Number of lines-- ------- g �� -r'"- Total 4eng---------- material-- h --------- -- ------ Type of filter materiaLC1---Depth of filter material -- ---=ya Seepage Pit: Distance to nearest well----------------------D;stan a from foundation--iometer_ Distance toDneP}hst lot Iine----------------- Distance 1--__:__-_-- - r^ ❑ Number of pits-------------- -------Lining ma 1 i ❑ fiom nearest well_________________Distance from foundation Lining material------------------------------------- Cesspool: Distance " iquid Capacity gals-. Size: Diameter--------- --------------- ------- ---De th------------------------------------------------------- - ----------------------------------------- -----n: _____.-.----Distance from•neard'st building-- � + -----._------------------------------- I -- - Privy: Distance from nearest well--------------------------- - ------------------------------------------ Distance to nearest tot ine F-.__._---------------------------- ----- -•- ------------------------- . p . _. -----------------------•-------- Remodeling and/or repairing (describe)------------------- ----------------------- 0 --------=-=--------- _________________________________ k f --------------------------------- ----------------------------------- k- I hereby --emit that I have prepared thisfapplication and that the work will be done in accordance with SanJoaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ _ wl -c ---- --�� --�T---- ---- ---(Owner and/or ontrac r� 5i ned ------- s etc. can b( 9 )- - f --- -------- -------- ------ __ Title)---------------------- -- - -- --- ---�---- --------------- By: ---- -BY ---------------------•---------------- ------- -- --- --- - e laced on reverse si e. (Plot plan, showing size of lot, location of system in relation to wells, buildings, P FOR DEPARTMENT USE ONLY , DATE------------------ t -- APPLICATION ACCEPTED BY-------------- ---- --- / , — r 4.� BY-------------------------------- ------- ' -..- ---- - - - - -- -- ---'------------------ REVIEWED ---------------------�-- DATE----- ---�--- -- --------:----------- -------------------- -- ------- -------- ------'- DATE-------------------------- -----= - ---------------------- BlJILDING PERMIT ISSl31 D. ---------------------------------------•---------•----------: Alterations and/or recommendations__________________ ---------- ---- -- ---•-------- ---------- e ------------------- ._._.----------- ____._-__ ..Y__._-.______t ------------- _ . r ___ _______ ------------------____________________________________.._.._..______..__..____.._..._._..________.____ -__- t .._._.-- ---` Date4 -- -- ----- ------------ M1 ------------------------------------- SAN FINAL INSPECTION :.-.-_-- -----------•------ r - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California y E59-2M Ravlsed 8.'59 F.P.Ca. ''�