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+3 APPLICATION FOR SANITATION PERMIT Permit No. __ z_ ----_... (Complete in Duplicate) - /Q Date Issued ------- Application is hereb pp y,rnade 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 ADDRES LOCATION__ ______ __ ______e ____ Owner's Name----- N1 ------ .5�--•-••--------- - Q --------------------------------------- Phone- - Address f -------•------------- ------------ - -------- ------------------------------------ Contractor's Name--- ---------_ ---.��R_/_5�----��d�i� � ----------- Phone '_ a_� a --- gym---------------- -----�`--��---- Installation will serve: Residence 5( Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrooms _Z_ Number of baths J.__ Lot size _______ Water Supply: Public system.x 'Community system ❑" Private ❑ Depth to Water Table -------- ft. k - Character of soil to a idepth of 34eet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No Rf New Construction: Yes ❑ No [X FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi T Distance from nearest we!!-----------------Distance from foundation------------.------"..Material-_.-_____.__-_.______-- No. of compartmen,ts-------------------------'Size--------------------------------Liquid depth--------------------------Capacity---------------------- i � isposal d: Distance from nearest well_________.___..-Distance from foundation---------------------Distance to nearest lot line___-_-_______-.__ Number of lines--'---------------------- >-'Length of each line-----------____--=----__ ---Width of trench------------------------ -- Type of filter material-------------------------Depth of filter material------------------ -----Total -length---------------------------------------- Seepage Pit: Distance to nearest well____J_QW�Distance foundation----1`40.....__-.Distan e'to nearest loft line`__.__.._ ( Number of pits------ ----------Lining material------ Diameter____ DepthS----------------- Cesspool: Distance from`nearest well-----------------Distance from foundation___________________lining material----------------------- p� 0 Size: Diameter------ ------Depth---------------------------------------------------- Liquid Capacity gals. f Privy: Distance from nearest well----------'-----r------------------------"-------Distance from nearest building------,---"-------------__----------........... Distance-to'nearest lot line. __----____-- == - Re Iin and/or repairing (describe)------- -- ---- --- �. 3 - -------- .�.�r--- - -- -- M =:_ r - - ~ ^� =----------------- ---- ----- ----------------------------------------------------------- --- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Ila7 and rules and r lations of the San Joaquin Local Health District. (Si ned g ) 'L -- ---- ------- = (Owner and/or Contractor) By--------- ------ --- ------------------------------------------------(Ti+le)--- ------------ (Plot plan, showing size of lot, location o s stem in.relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - ------- -----------------------------------------------------------...--- DATE- ------------- i f� REVIEWEDBY----=----------------------------------=---------- -- - -------------- ----- -----------------------•------ -------- DATE- `y' - I BUILDING PERMIT ISSUED----------•--------I---------- - ---------------------------------------------------------- DATE------ Alterations and/or recommendations--------------- ---------------------------------------------------------------------------------- -J n�r l-1 A_7'1v!..... ,�A�t112 ---------2 -------47r __. .. if � --------- r - �r�r c sfi,� ' " - ` _7 4r ...... �'"',a ,r�r =--- - ------------- FINAL INSPECTION --- _ �- -- . -- --- Date---/0-----!7_7-1__;_ 7 _ ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street �ES-9-2M Stockton, California" Lodi, California Manteca, California Tracy, California , Revised 1.57 F.P.CO.