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APPLICATION FOR SANITATION -PERMIT Permit No. __,La__ - (Complete in Duplicate) ?h Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the work herein described. This application is.made in compliance with/County Ordinance No. 549. -- lG --.p d~ .IGS.�Ae r.�„•, W1114W1114r�: o�` 5"r0 J JOB ADDRESS AND LOCATION--.-J-------®-, ® C, -:-D --.. pltlG-`--rSi G.---- ------D_7T=--�^!1'--�'/�dG--� :ed!I Y Owner's Name-----------Jo ----- - Phone Address 4- - -- - = ---------------------------------------------------------------------------------------------------------------------- .-.�: Contractor's Name--------� ----- --•- - - - ------------------------ --------------------- ------------------------------- - Phone----------------------------------- Installation ------------------ - --•-------- Installation will serve: Residence R- Apartment House E] Commercial ❑ Trailer Court ❑ -Motel'❑ Other ❑ Number of living units: __/__ Number of bedrooms _aZ_ Number of baths -_ Lot size --_1 ,74!e Water Supply: Public system ❑ Community system ❑ Private 8�Depth to Water Table 1�e_' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made:. Yes ❑ No R" New Construction: Yes [IJ."No ❑ FHA/VA: Yes kwmo Z'— TYPE ' -TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or`cesspool,permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-,2PQ_ _Distance_ rom foundation--_f ----------Material_--- - _-_A---+ -_-_ ----- --------. No. of compartments_._...2..---------------Size--- - -- �_._--Liquid depth----X_—E .........Capacity-.,/OV------ Disposal Field: Distance from nearest Distance from foundation;-J_aC_-________.Distance to nearest lot line__v3.4_______ 0� Number of lines _______T____----------------Length of each line.g�__._________________-Width of french---e�_Yj�_______------------- Type of filter material-/ _1Qd_'_f�__Depth of filter material_---��..........Total length-----*2_F_.D-- Seepage Pit: Distance to nearest well------------- ---------Distance from foundation___.....-__________.Distance to nearest lot line__________.____._ O ; ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------_ -11 m Ij Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material------------------------- _________-_. ;" El Size: Diameter--------------------------------------De th---------------------------------. _ _Liquid Ca acit Depth q P Y gals. Privy: Distance from nearest well-------------------------_--------------------------Distance from nearest building___-----_________________ Distance to nearest lot line Remodeling and/or repairing (describe):______ _ tL✓_._____ -d `- � ------------•------------------•----:--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------._ -------------------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------- ----- --------------------------------------------------w--------------------- -----------------------•----••-._---------------------------•--------------------------------------------------------------------- ---------- C I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned 9 )--------------------------- -------- --------- ----- - ---------- --- - - ---- Contractor) BY:-------------------------- - - ----- ---------------------------------------------(Title)---------�---------------------------- (Plot plan, showing size of lot, loca&6n of system in.relation to wells, buildings, etc., can be placed on reverse side). \ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bl DATE_��_ i Com. ----- REVl3=WED BY - ------------------------------------------------------ DATE-- ' BUILDING PERMIT ISSUED------- -------------------------------------------------------------------- -------- DATE --------------------------- Alterations and/or recommendations:------------------------------------- ---------- ----------------------------- --------------------------------------•---------------------------------------------------------------•-----------------------------------------------•-------------------------------------------------------------- ---------------------------------------- -------•-------------------------- -----------••-------- h FINAL INSPECTION BY:--- -----------------•------------------- Date------- SAN ---- JSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street S+ock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P,CO.