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M. —meq APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) l Date Issued Application is hereby made to the San J quin Local Health District for a permit to cons#ruct and install the work herein des"cd. ed. This application is made in compliance -th County Ordinance No. 549. JOB ADDRESS AN ILOCATIOI j.___ __ -_-��-�J----- - ---------------- � _ � - ----------- Owner's Owner's Name---------- --,�- - _ ------------------ -------..- _ Phone__ ------- Address 0. � � � --------- ----- ------ - ----- r -_ ----------------------- - -:-a�-----�- Contractor's Name ----------e_� Phoney b- 6 D ------------------------------------•-- -• -•- Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trai€er Court [.] Motel ❑Other ` Number of living units: ________ Number of bedrooms -------- Number of aths _t- Lomat s e Water Supply: Public system ❑ Community system ] Private Depth to Water Table ------- t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within-200 feet.) F Se tic Ta Distance from nearest we€ p � Distanc from foundation __.______.Mat nal_____________._ _ No. of compartments Sizg__ __�_��__ .. Liquid de th____---_-_.�_________Capacity_.� P 9�✓----------- q P. �. Disposal . field: Distance from nearest well--60----._Distance4rom foundation-X-J--------Distance to nearest lot line Number of lines______ _._. Length of each line___. �� Width of french '�__.____________ Type of fitter materiaek e 1Depth of filter material---- length___s -_---_-_----_- Seepage Pit: Distance to near st welL�4)0-;--Distance om foundation__. :.___.Distance to nearest lot line____-___-. Number of pits____________________Lining material____ t__-__ ________Size: Diameter--,-30- -��--.Depth__ _ ---_ Cesspool: (?istance 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): -------------------------------••------------------------------- ------------------------------------•---------------- ---------------------------------------------•--------------•---------------------------------------------------------------------------------------------------•-----------•------------------------------------------------ I her by certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance, S+ate Lawaanrules ar�d regulations of the San Joaquin Local Health District. Y y (Signed)--------- ---- -------------------- /n------------- --- ------ - - ---------------------------------- r Contractor) BY• - -_�:--------------(Title)------------------------------------•--------------•------------ (Plot pian, showing size of lot, location of-sys+em in relation #o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -' -------------------------- -------- --------------------------• DATE- -------• --- REVIEWEDBY-------------------------------------- ------------------------------------------------------------------- DATE--- -------------- ---------------------------- BUILDING PERMIT ISSUED------------------ ---------------------------------------------------------------- DATE----- --k' Alterations and/or ----�-- - �S recommendations------------------------ --------------------- ----------------- ------------------------------------------- -- - ---------•---------------------------- -- ---------- -Qo -------------- _ -----� .��------------ ---- - - --� -�--- - - ---- - ,�._ .,tee...__. �. ��.�. - - - -------------- ° �•� J.utlLr„ca-... ....�5 .,!��1F� ,4_r _r .� `.,t=-Al?� ------------------- -----Q�------ ---- 1 q FINAL INSPECTION BY:. ?SAN G�t1V.------------------------- Date------ l ` 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-9-2M . Revisea 1.57 F.P,CO.