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r, i V r xl`rl APPLICATION FOR SANITATION PERMIT Permit No. Q e`I (Complete in Duplicate) / d d Date Issued --- Application -Applicatin 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 im.compliance with County Ordinance No. 549. 6e JOB ADDRESS AND �LOCATION---- ��_�-��4�-�9„ --G.11 -B_�_-��----------- �--- --------------------------------------------------- Owner's ---•---•-------------------------•--------..-.Owner's Name---------_-/!.;Z- Z-1 7��`� --- -------------- Phone------------------------------------ Address---_,_gC"e x.21 /1"�C�_/fie e ----------14? -;Y------ Ot ifil .1� Contractor's Name--------- � � ! - �" ' lr �/-- � ------------------------------------ Phone------------------------------------ Installation will serve: Residence ❑ Apartment House ❑ -Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __7__ Number of bedrooms ---2- Number of baths - -_ Lot size __, -� _ ` `I?i- ------------------------- Water Supply: Public system E-1,Commun'ity system ❑ Private ❑ Depth to Water Table 349-4. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E--nardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No gj-- FHA/VA: Yes ❑ Nom-^ TYPE OF INSTALLATION ANDMSPECIFICATIONS:= (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material__-__-----:---..__-----_------_-__--- ------_---. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well___.'_..-Distance from foundation_ eW—'r----Distance to nearest lot line-_:-' [g�' Number of lines--------- ------ -------- Len th of each line- Width of trench.----/ �f_`--_-___-_- g ��----- Type of filter material-_/_ -Depth of filter material-_-,��----�-_____Total length--_-__J�- ._--- d Seepage Pit: Distance #o nearest well___-' -- Distance'frgm fou ation_-_�! _____-.__.Distance-to nearest lot line-��_--_..-- Number of pits------�-------------Lining material-��- -._rSize: Diameter___--___. ---.Depth_.___ -!�._____-----.-----_ x Cesspool: Distance from nearest,well----------------:Distance from foundation__.---------------- Lining'material---------..-------------------__-__- ❑ Size: Diameter---------------------------- `----- Depth---------------------------------- ----------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from- .nearest building_-----------_--------------------------.-- ❑ Distance to nearest lot line---------- ---------- --- ---------------------------------'-------- ----- - ----------------------------------------- ----- ..-.. Remodeling and/or repairing (describe):__..---- ' -1 <' ----------- t --------------------------------------------------------- -------------------------------------------- ---------------------------------------------------------- --------------- - --------- - ------------`-^-----------------------------------•--------•--------------------------------------------------------:---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and re lations oil he San Joaquin Local Health District. . • Contractor] \ (Signed)----- By:------------------------------------------ -- -----1W------- ----------------------------(rtle)---` - - [Plot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse s' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- --- ------- DATE �j REVIEWEDBY------------------------------------------- - --- - ------------------------------------------------------------------- DATE------ ------I-- ------------------------------ BUILDING PERMIT ISSUED-------•-------------- -- - - -- --------------- -----------•------------ DATE-----.-' ------------------------ -------------------------- ----------------------- Alterationsand/or recommendations:----- ----- ------------------------------ --------••-------------•------------- ---------------•---------------------------------------------------- ----------------------------- fj ` ----------' :_....- -•------------------------------ .._....-•------•- ---M .--------- ---- ----------------- Date ' t=-----=------------- -------- FINAL IN5PECTiO _B ------------------------ w 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 Tracy, California ES-4-2M , Revised 1.57 F.P.CO. I