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APPLICATION ` N FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S - t-f(6'�-C 4)A ,-/Pf Date Issued _-- - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein erein described. This application is made in compliance wi h C unty Ordinance No. 549 JOB ADDRESS A DOCATION ----- -.. / 9(---- �--/ ------------ Owner's Name___ . ;e 4W -- ---------- -- --- Address----- --- --y ------ Contractor`s Name___________ _ �- Phone ------------------------------------------------ W�fa7 ----- ------------ --- - Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer. Court ❑ Motel [❑ Other IBJ * f Number of living units: -------- Number of bedrooms -------- Number of baths' 440't size ---_r r Water Supply: Public system ❑ Community system ❑ Private [?]�Depth to Water Table �92 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T (No septic tank or'cesspool permitted if public sewer is available within 200 fe ef.) Septic nk: Distance from nearest well-/0_d._------Distance from foundation___ t _- ----_.---- ------------ No, of compartments ------------Size-_ 7__`-, ---------.Liquid depth---� ? -----Capacity---- Disposal a ac,Disposal -bid: Distance from nearest well-/"--, Distance from foundation_ � ��-- .__.Distance to nearest lot line______.-_�. Number of lines---------.1-------- -- __-- Length of each line----- Width of trench------- -------------- Type }-- ------------ � 9 Cn „ of filter material-_4 c_ dcfG_Depth of filter material------1 ---_---__Total length------------- 4--"------------ ------- r / Seepa it: Distance to nearest well_ _Q7t_-_._.___ Distarrc fpm oundation__ •__ ---- � � ._____.Distance to nearest lot line__________ (�• 01 Number of pits.________..---.__Lining mat erial- -C�I 'C� Size: Diameter____� � �� -- ----- Depth------,?�S----------------- --Distance - ---------- gyp, Cesspool: Distance from nearest well __Distance from foundation_-----___--.__--__.Lining material_-.__--____-___-------__-----_-_---- 1 1 ❑ Size: Diameter------------------------------------- Depth------------------------------- ---------------------Liquid Capacity gals. Privy: Distance from nearest well------------------- from nearest building ❑ Distance to nearest lot line---------------------------------- - Remodelingand/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, St a !aw , an ,,pies an regul ions of the San Joaquin Local Health District. (Signed)------ ------ -- ---------------------------------------------------- --------- (Owner and/or Contractor) $Y�-------------------•-----------------•-•----- � --- - - -------(Title)----- --------- - -------------------------------------------- - (Plot plan, showing size of lot, locati n of system i re ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --- -`Q'---------------------------- \ -----------------------•----- ----- DATE_-----�=--��---- ------- ----------- -- -, REVIEWED BY----------------- ------------------- ------------------------ DATE - -- ------------------ UILDlNG PERMIT ISSUED------------------------- --------- ---------- --------------- -------. DATE.--------------------------- terations and/or recommendations:--.___.._____.___ - -------------------------- 1 1 ----�------------- �`-N------- K--- ------ .- ''_-z - .__ FINAL INSP BY Date----------- � lr, 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-9-2M , Revised 1-57 F.P.CO. t