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L ' APPLICATION FOR SANITATION PERMIT {Com late in Duplicate) p Date Issued Application is 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. /� Aft JOB ADDRESS AND LOC TION------- 5` l� �t )��---------------- —V 1 1_R ---------------------------------------- ---- -- Owner's Name_______________ _ Phone �.3C2 ------- orl A/ Address-----------------ZJ/--------- -- --- / - 1 , (lQ Contractor's Name----------- --- --�<_--- � i= Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I•_I Number ofliving units: _-`---- Number of bedrooms �.. Number of baths __/__ Lot size .-- �___XfI Q---------------------- Water Supply: Public system EW--Community system 0 Private ❑ Depth to Water Table&-'ft.II " Character of soil to a depth of 3 feet: .'Sand ❑ Gravel ❑ Sandy Loam ElClay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes El No [ < New Construction: Yes ❑ NolQ4—.FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS. \ r` No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Soa 'k: Distance from nearest well_________________Distance from foundation_--------------------Material--_____-_-____________-______-_.-_-_-_----_____- l No.;of compartments---------- ------- ----- Size depth Capacity.. fill - K 'Dis Field: Distance from nearest well.- Distance from foundation___ V Distance to nearest lot line _____ Number of lines------------------------- . Len th of each line______. Width of french ------------ Length g _. j ---------- Type of filter material-___-R --Depth of filter materia!___._fr ------ Total length-------- __.________________ \ g A t Seepage Pit: Distance to nearest well_ iP t✓f--I_Distance.from foundation___:. _,_..___.Distance/to nearest lot line__.~f__� Linin material-__ p:.Q ---Size: Diameter_____---------De th_____�, ___________________ Number of pits------�---------- 9 t FCf? �. wt i ! l.. - Cesspool: Distance from nearest wel€--------------1_Distarc from foundation-__ ________ _--- Lining material___-_-_____--_._____:'___________----- ❑ Size: Diameter------------------------------------Depth-------- = '� ----Liquid Capacity----------------------------gals, ___Distance from nearest building Privy: � Distance from 'nearest well---------------------------------------------- 9---------------- ------------------- -- rA '� ,I —L ❑ Distance to nearest fat line ---=----------------------------•-------------------------•--- -------------------------------------------:--------•----- s . - ' Remodelin and/or repair crib:_----- �'r 3- _' = --J...-- I � _ ____________ v 1 k --------•--- --- -------------- ----------------------------------- ----- 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 a d rules and1re uiati of the San Joaquin Local Health District. (Signed) --F -d`------ i «�' -- ------ Owner and or Contractor) By------------------------------- :--- --------------------------------------------{Title) ------------------ ----- - --------- ---- - (Plot plan. showing size o ot, I ation of system in.rel io to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -------------------- DATE-------' S,f---- --------------------------------- ---------- ---------•---------------------- REVIEWED BY--------------------------------- DATE—t----- q ----------- ------------------ BUILDINGPERMIT ISSUED----------------- --------------------- ---------------------------------------.------------------ DATE-------------------------------------- ------------------- Alterationsand/or recommendations:-.---------------- -------------------------- ----------------------------------------------------------------------=---- ----•------------------------------ ,-4r ---------------•----------- - g --------- - -� ��. / F',------- � r�- '��-----C'�r�',_' � -r7-- ` ------ ---- :--------46� -----------K_ ------------------------------------------------------•--------------- ---- ---------------------------• ----- - FINAL INSPECTION- BY.--.- ----------- :n-----=-----------== Date------------ f 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 k` Revised 1.57 FY,CO.