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fi APPLICATION FOR SANITATION PERMIT Permit No. ....... (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. Thisap ;lication is made incompliance with County Ordinance No. 549. JOB ADDRESS AND ------ -9 ---- - Phone--------------------------------- Owner's -- ---------------------------------- Owner's Name—,efts.-w-449 ----------------------------------------I------------------ ----------- Phone------------------------------- ----,00 ....0 #' Address_. ------- -- --- --- --------- ---------------------*.... Ael(10 -----------------------------*---------- --------------------------*----------- A-------------- Contractor's Name-----� e-. -;4------01 ------------------------------------------------------------------------------------ ----------- Phone-------------------r--------------- Installation will serve: Residence R1 Apartment House E] Commercial [I Trailer Court [] Motel E] Other E] Number of living units: Number of bedrooms .3____ Number of baths --/---- Lot size ------------------------------------ Water Supply: Public system El Community system El Private 4] Depth to Wafer Table"-- ff. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Q0 Clay Loam E] Clay 0 Adobe 0 Hardpan 0 Previous Application Made: Yes E] No ;Z ' New Construction: Yes, No E] FHA/VA: Yes 0 • No M TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or`cesspool permitted if public sewer is available within•200 feet.) Septic Tank: Distance from nearest w6l-47�117---4 ------Distance from foundation---/Q--/Q-- Material-4-o',W14----------------------- No. of compartments--- --------------- --------Liquid depth--------,y---------- ---Capacity-400----------- Disposal Field: Distance from nearest well--S*P.t------Distance from foundation----1 Distance to nearest lot line_______.____. 5---------- - -L Leng each I' --------------------- Number of lines---'t-------- tr6� ea ine--------J.VV-�----- ----Width of tr�nch.--Ay Type of filter maf,-,1-i�.I";-----q-Kk----�Dept-h of filtE�ri material----- ----Total length'--*t,"---�------------------------ Seepage Pit: Distance to nearest,welf-111L rLomkfou.ndaf Distance jo)nearest lot line----------------- ❑ - ----------- ---- er-----A-----------------Depth-- ------------------------------ Number of pits.-..`-------- Uning:mafe7rial---------------------- Size: Diamet' Cesspool: Distance from nearest well-----------------Distance from foundation__--- --_.._.Lining material-___________________________________.. ElSize: Diameter---------------1------------- -- Depth--------=-•----------------- --------------------�Licluid Capacity---------- -- -- - ----gals. Privy-. Distance from nearest well-__________________________ ______________---_Distance from nearest building____________-__---__---_-_--______.._. \ ❑ Distance uilding------------------------------------------ Distanceto nearest lot line----------------------------- ------------------------------------------------------------------------------------------------ --------------- ----------------------------I-------------- Remodeling and/or ----------------------------------------- repairing (describe):--------- -- --- ----------- ------------------------------------------- I —------- ------------------------------------------------------------------------------------------ ----------------------------- ----------------------------------I------------------------------------------------- - --------------------------------------------------------=----------------------------------------------------------------__----------------------------------------------------------------------------------------------- r 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. (Signed)..........3,__/4 —--—------------------------------- ---------------------------------------------------------------(Owner and/or Contractor) By:---------------------------------------------------------------- -----------r--------------------------------------------------------(Tif le)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc ,,_San,be placed on reverse side). . FOR DEPARTMENT USE ONLY -0Q 00,110F or APPLICATION ACCEPTED BY--- --- -------------------------------------------------- DATE-- -- lw—f------------------------------ REVIEWEDBY------------- - ---------------- -- ------------------------------------------------------------------------ DATE------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:--------=- --------------------------------------------------------------------------------------- ------------------------------------------------------- -----------------------------------------------7----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------------------------------------------------------------------I------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------------I------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- FINAL INSPECTION ------------------------------------ Dafe--#F_----- -----0 --- ----0,7------------------------------------------------------ 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 E5-9-2M Revisea 1-57 F-P.CO.