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!b� APPLICATION FOR SANITATION PERMIT Permit No. _�L_`F- J7 3 1 - � (Complete in Duplicate); Date Issued 131— --....... Application is hereby made to,the6an Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County O dinance No. 549. s /2- -------- Owner'sAADDRESS AND LOCATION---- - --------------------------------------- -----1. ----•- r ---------------------------------- Phone-----------------------•---•--..,-_. Address---------------1--?V I/I � = 00 •--------- -------------• ••-----•-•---•--- Contractor's Name------------ = -r �. �,� ------------ --------------------------��------- Phone-- -----------•-•-• Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other ❑ Number of hiving units: --4- Number of bedrooms _..- Number of baths __1-_ Lot size ___ 6_- k__( - Water Supply: Public system Ja+ Community system ❑- Private ❑ Depth to Water Table _-Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay n .Adobe LV Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes E] No FHA/VA: Yes El - No rb + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within'200 feet.). - ept Distance from nearest well_________________Distance from foundation--------------------Material -___---.-___---.____.__---�____-__._--_.,_-_.-_. No. of compartments----------------------- -Size--------------------------------Liquid depth--------------------------Capacity------------ field: Distance from nearest well__.A/0, 16Distance from foundation___ _-.___-- J•----Distance to nearest lot line_:Zs-_ __ Number of ------J------ - -=---- g r th.of each line---------- ,------- lines-----= - - - --LenWidth of french------ Type of filter material------�r1G-__Depth"of'fiiter material-----1d6{'_----------Total length-----.,?Q__-_----_______ Seepage Pit: Distance tc nearest weii_-_=,A'/O, Distance . foundation__: __.__.Distance to nearest lot line. Zs _ , - Number of pits------ !Lining material___-- --D_Cj Size: Diameter-- --------Depth--- �5-------- -------• tT\ _Cesspool: Distance from nearest well I:____;___-----_Distance from foundation__+____ __________ Lining material ____--__________-___._-___----___.. ❑ Size: Diameter----------------- -�--- ---------Depth--------------------•------------ :- --------------Liquid Capacity----------------------------gals. , rivy: Distance from nearest welt____ -----------------------.---.--------------Distance from nearest building ____________-_____ • ` ------.----- ❑ Distance to nearest lot line---- -------------- = - - -= __ = ----•---------------------- Remodeling a d/or rep irin describe)________ _ ______ _ ---- --- -----=---- --- - -..-----•- 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 laws, and r e and regulati the San Joaquin Local Health District. (Signed) ---------------- -�Owne�and/or Contractor) By:------------------- ------------- ---------- -- --� ------- -----------------------------}Title)---- +--------------- (Plot plan, showing.size of lot, location of system in.reation to , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�--- --------------- - -----------------------------------------•-•--------------------- DATE-7— REVIEWED ATE REVIEWED BY ----------- -- - --------------------------- --------------------------------------- DATE---77..----------------------------------------------------- BUILDING PERMIT ISSUED----------- ---- --- --- - ----- - --------_-------------------------------- DATE--- Alterations and/or recommendatio :-- ---. _. -- _ _ _ s = = -------- ----- -----------------------------------------------------------------_-'------------- =--- -- --------------------------------------------------- -- FINAL INSPECTION BY:. Date-•:------ 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 i ES-9-2M , Revises 1-57 fa a.