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.i.- i APPLICATION FOR SANITATION PERMIT Permit No. _ t__G (Complete in Duplicate) Date Issued --- S T kcation is herebymade to the San Joaquin Local Health District far a permit to construct and install the work herein described. ♦pisapplication is made in compliance with County Ordinance No., 549.' JOB ADDRESS AND LOCATION r � Owner's Name 'i-'- `- --- ----------------- = Phone--_.------------------------------ Owner's Name----- Address- hone-- ------------------------------- Address. i �f 'l' -----------------------------------------•-•-------- ---------- Contractor's Name----------------------- ---------------------------------------------- Phone---------------------------------- Installation will serve: Residence EKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel/❑ Other ❑ Number of living units: __F_.__ Numbei of bedrooms _ - Number of baths __._____ Lot size ___.____ Water Supply: Public systarn'w Community system ❑ Private ❑ Depth to Water Table J3 '_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No_❑` New Construction Yes'B,__ ❑ FHA/VA: Yes ❑ No i f TYPE OF INSTALLATION AND SPECIFICATIONS: • ( p r p permitted p se, r is available within 240 feet.) No septic to o�'cess ool ermitted ifi ublic Material 6�stance from foundation__ ' --- ` Septic Tank: Distance from nearest 'we11 �3Vt,(D" r j• � '� G t � --- -Ca acini o No 1 of compartments- r - e -- Liquid depth p Y := Disposal Field: Distance from nearest ell- — Distance foundation___,c �_--__ istance to nearest lot line___, __---- �! th of trench-^-- _ - N'mber of lines-_---____-_ '- - Length of�ya 'Irl �: "�d Type of filter material- ►_______Depth of filter material---- : -------------Total length______.!_----------_____�_� s Seepage Pit: Distance'fo nearest Zell-.-I------------------Distance from foundation----_____-----------Distance to nearest lot line----------------- A ❑ Number of pits-------- Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El __________________________________❑ Size: Diameter------ ----=- 4---- ----------Depth----: -------------- ----------------------- --Liquid Capacity_------------------------gals. Privy: Distance from nearest'`well___-----------------------------------t-_F-------Distance from nearest building----------.______________________-----_._. ❑ Distance to nearest lot line-- ------------------------------------ -------'-----------------------••-------------------------------------- Remodeling and/or repairing (describe?. ` i = �r---------------•-----=-----•------•- •---------------------------------------------------------------- " I \ ----------- -------•---------- --------.-,-�--------- = ---------------•--------------•----------•-------------------------------- ----------------------------•----------------------- --------=---------------------------------------------------------------- -------------------- ---- { =-------- ----- -----------------•---•--------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rules and regulations of the San Joaquin,L cal Health District, Signed .0.1_._ .._sem- __ f!.�. _i1 �'' ` ' -----------------------------------------------------(Owner and/or Contractor) By:-------------------------------I-------------------------------------------------------------------------------------------------(Title)------------------------------------ ---------------------_----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ 1]ATE_______ ;-�: = �---- ir�y---------- --BY------------------------------------- ------ � 0 DATE !✓ i BUILDING PERMIT ISSUED_... ��' —-------------------------- - DATE-- l i Alterations and/or recommendations------------------ r ---------------------------•------------- -----•----•------ ------------------------------------------------------ --- ------- -•---- -•------------ ------------ -------------------------------------------------------- ------•-------�-mrd- ---- ••- - �- - --- --------------------- ---------- - - ' • • AAi" - FINAL INSP ,,�"pito---- � T i"""ce- -SAN JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Street no West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California /J E5-9-2m , Revises 1.57 FRCO.