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APPLICATION FOR SANITATION PERMIT Permit No. ..... ............/--_-_ (Complete in Duplicate) S Date Issued __ - ..z� 2 Application is hereby made to the'San Joaquin Local Health District for permit to construct and install th6 work herein described. This application is made in compliance with County Ordinance No. 549, "JOB ADDRESS AND LOCATION qQ --3 14 i - ---------- ----------- Owner's Name--------------tJ_-1-__f,__ --r------ ------------------ ---`-------------------------------------------.::,_:; Phone-----------•--------=--'----------- Address---------------------- `------------••---•--- J7 - �• t Contractor's Name . -- '/� � *+ llF PhoneQ1/ Installation will serve: ' Residence Q--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l.__ Number of bedrooms __ Number of baths �- Lot size ------f_ --------A______-__J'__ ------- Water Supply: Public system'❑"Co"munity'system ❑ Private [Depth to Water Table---------- ft: '> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHj ardpan ❑ Previous Application Made: s es F1 No U`New Construction:—Yes ❑ ' No'[:] FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: = �-- (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) E ' Septic Tank: Distance from-nearest well--- ____:Distance from foundation__-./_,�-------Materiai_________________ _ _ _ f No. of com artments_-__ Size_ Ei tr # P Liquad depthf� CapacitY T 'o " 3 E., , Y *. Disposal Field: Distance from nearest•well_��__ �Distance ram faundation__�-Q_ _____Distance to nearest lot line_____________ ©� Numberfof lines__;,_______ ___________�_ _Length of each line_ Qr__ - ��d_fWidth of trench-----�s�_5 _`�__-_________ Type of filter material ------------ Depth of filter material----/��_r_`__._Total length______�_$ __�------------ ____ Seepage Pit: Distance 4o nearest well__`_________________Distance from foundation.....................Distance to nearest lot line-______________-_ ---=-------------------Depth------------------•--- ------ ❑ p� gmaterial .. Cess ool: Distance from nearest well_________________Distance from foundation-__________ Humber of its-_.________.__________Linin __________________ __Size: + .----.Lining material---------------------------------•---- �- ❑ Size: Diameter---- 'I-------:--------,--'---------Depth------------------------------------ ---------------Liquid CapacitY-.-- gals. Privy: Distance from nearest well-_________________I-____.________.__________-Distance from nearest building______-__________-_____.______-__________- ❑ •Distance:to nearest.,lot-line____---------____________________ - - Remodeling and/or repairing (describe)_______________ = ; --------------•---•-•-•-----••-----------------------------------;--------------------------------------------------•-------------------------------------------------------------------------------------------------------- ---------------------- -------------------------------------- ------•------------------------------------------------•--------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State lawwy gulfs,Ap�1�.r�lations of the San Joa uin Local Health District. S. ned fSE:FTIC_YYTAN��vvK VSERVICE ` ( 9 ) f ------------------:--------------- (Owner and/or Contract '5&.Miner Amy a Stockton tUlf� � 7 }, s (Title)---------------------------------------------------- w (Plot plan, showing Aize o "iof, cation of system in relation to ells, buildings, , can be placed on reverse side). ..-� : FOR-DEPAR ENT USE ONLY APPLICATION ACCEPTED BY___ ___ DATES._..._ I REVIEWEDBY------------t--------------------- ----- ---- =-------------- ---------------------------------------- DATE- _ BUILDING PERMIT ISSUED------------------ .-� -- ------------------ ----------- Drf�trTl___-- -- .. �------_--- Alterations and/or.recommendations:__ r °'`st,-�s�_ +°� "�'__lf `;-.�'»A_ •�: --• _-•"�` �,,�►„ � -----------------'----------------------------° ( -- ...... - i- ----------- - t ---- I .. --- ----- - t. R e t �,.7? y+t----------------- FINAL INSPECTION BY: -------------- Date--- e_ ------------- SAN -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street :�., �.fy :132.5yc6inora'S+root; '; 814 North "C_' Street Stockton California Lodi California „ , , .. Califona 'iM 3 :v' Tracy, ES-9-2M : Revised 1.57 F.P.CO.