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L ` G i t APPLICATION FOR SANITATION PERMIT Permit No. [Complete in Duplicate] j Date Issued -_/�?7A_7_ f'�7KApplication 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---.-_ _ - 10" ----------- - -------------------------------------------------------------------------------- - - -- --2222-- a Owner's Name- -----•��------� Phone ----------------------- Address ' ----------------------------------------- ------------------------------------------------.... S2t±.. ------------------------------------------------------------------ Contractor's Name---- - --- ----------- ---------- Phoner '`�^ � -------------------------------- Installation will serve: Residence J j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_--- Number of bedrooms ,#,— Number of baths ---(--_ Lot size --- 3Kx/P ---------------------------------- Water Supply: Public system 9— Community system ❑ Private ❑ Depth to Water Table sp�. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeQ& Hardpan ❑ Previous Application Made: Yes ❑ No Fj_ New Construction: Yes a 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-----------------Distance from foundation--------------------Material--------------- _-___----_ -- • 2 222---:--•--~"`-. ❑ No. of compartments- -----------------------Size---•----------------------------Liquid depth-------------------------Capacity ----------------------- Disposal Field:- -'Distance from nearest well--- r_----Distance from foundation__6P-__r_------Distance to nearest lot line---s"'ZL ,_'_---. Number of lines----------:_L---------------------Length of each line------'~------------------Width of trench-----2!'_�'-__________---_-- Type of filter material__WaC_ __Depth of filter material-'1_B"_�_________Total, length----- , _.---_------------- --- Seepage Pit: Distance to nearest well----A��___Distance from f undation--_10---_c__._--.Distance to nearest lot line---- FALNumber of pits._.-,_______________Lining material __ _C/___-Size: Diameter --____--Depth__..�?r3 !__-______-__---- Cesspool; Distance from' nearest well` ---:___----- Distance from foundation_______----____ Lining material__---_------------------2222- --- { Size. -222222 22----2222-2222-- -2222--Depth- - ------------222222 22---2222- - ---____U uid Capacity----- --------2222-- ----gals. Privy: Distance from nearest well______________________ ----------_ -------Distance from nearest building -------------------------------- --- ❑ Distance to nearest lot line Remodeling and/or repairin (describe :____--waj_ --____-_ } - - -7 - o------B ------P-1l__�--�a-Q-_.-�=--=��-��----------------2222-- 59-F-FO-IF -------- 11 5 `/ ( -- l -------------------------------------------------------------------------- --------------------•----------------- ---- I ----------------------------------------------------------------------- -----------2222-- ----------2222---- -------2222-- -------2222-- , ---------------------------------- ------------------------------------•-------------------------------- ------------------------------- - ---------------------------------------------------------------------- 7------ 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 and rules and regulations of the San Joaquin Local Health District. � AL- T � (Signed)-- r -------------{Owner and/or-Con tractor By: -------------------•••--------------------- --- {Title]-. -_r----- • - -----------2222-- Q_��` ��------- 2222 - - _ ------------------- (Pl ot plan. showing size of lot, location of system in .relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------` k ' �� - DATE ��' -- -----------------2222-- - REVIEWED BY - -- ------------2222-- - ------------2222--- ------------2222-- 2 222-2222-- DATE-------------- -------2222-- ------------�-------2222-- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE -- --2222---------2222--Alterations and/or recommendations:----------------------------------------------- ---------- ----------------___ - - ----2222-- - ------------------------------2222-- - ---------------------•----------•2222-------•--------------------------2222-- ----------•---------------------------------------•-------•-- -------------------------- ------------- -------------------------------------------------------••----------------------------------------------------- ------------------------------------ __ - 1=_P r O_ -{ --------- -------------------------------------------- ------------------------------------- ------------------------------------ --- ------------ --- - - ----------2222-- --- 2222-- -2222-�----- -------------2222-- ------------------2222=- -=--=----�-----2222-- 2222-- ---- ------------------ ---------------- -------------- ------ ----2222-- --•-- ------ 2222-- -- - ----------2222--- 2222-- -------2222-- -- --------2222-- -- - - -------------------------- -----------2222-- ------------------------------ FINAL 222-- -FINAL INSPECTION BY:. - - - ------- Date----- I�-1 .`-S 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--4-21x1 Rev-sseci 1.57 F.P.CO.