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NN, APPLICATION FOR SANITATION PERMIT Permit No, Z�14C_C {Complete in Duplicate) r Date Issued Application 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. . l JOB ADDRESS AND LOCATION_-_.__--_- f_ -0 -- --------------- d --------- ----------Owner's Name = ----------------------------- i Address � ---------------------------------------------- ------------------------------------------- Phone------------------------------------ ------------------ ---- Contractor's Name________________ _ T.10AA...... p ❑ • ----------- Phone. / - - ------------------------------------- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court C] Metal r❑ Other ❑ Number of living units: __/---- Number of bedrooms --_ --- Number of baths - at / �_ Lot size .S"C� -,S Water Supply: Public system 21-*1commun'ity system ❑ Private ❑ Depth to Water Table Y4. f f. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No [4-`<ew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or'cesspool permitted if publiWw r is available within 200 feet. - Septic Ta Distance from nearest well- ) �p�c ZI 1 . __ stance from foundation--__�DMate�al_-4-..5�____ _ ___ IMO No. of compartments--------©2.-_-__ - - - -- - ------$ize--`-�---��--��-�s-----Liquid depth-----��-----Ca acit � p Y �,oDl . po I Field: Distance from nearest well from foundation -.Distance to nearest lot line-------------- Type it lines---- rial-------------------------Length of each line----------------------------- Width of french----------------------of filter material-------------------------Depth of filter material------,__---_- --- ------.__-Total length------ -------------------- •------------- e Pit: Distance to nearest well----------------------Distance from foundation-_--_-_-_ Distance to nearest Iot line-_._-._-----__--- Number of pits----------------------Lining material------------- ----Size: Diameter ---- ---.Depth------- --------- - - ( ------- - 11 esspool. Distance from nearest well_-_-------_----Distance from foundation_-----__---._------Lining material_____-____ ❑ Size: Diameter--------------------------------------Depth---------------------------- - --•-----------------Liquid Capacity- ---- --------- --------gals. Privy: Distance {rom nearest well_____________________________ -------- Distance from nearest building------------------------ Distance to nearest lot line1-------------------------------------------------- , ------------------------------------- Remodeling and/or repairing (describe):__ -----•-•---------------------------------------------------------------------- • - ti -- -------•---------------------------------------------------------------------------------------------------------------- - 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 rules and regulations of the San Joaquin Local Health District. (Signed)-------�e��----' -'�+.�------ - - caner and/or Contractor) By:------------------------ I (Title)----- --- --- Ll �-------------------------------- - ---------- (Plof plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---- - ------------- 9 ---- --------------------------------- ------------------------------- DATE----�---~---�'-----J7f- ----------- REVIEWED BY----------------------- -- - --------------------------------- --- --------------------- ---- -- DATE ---------------------------------------------- -- UILDING PERMIT ISSUED ----------- _ - -------------------------------- -----------Alterations DATE----- -------------------- - --- -------------------------- and/or recommendations:-____--__-----.-_-_ _ ---------------- � f { ----- ---- - ----- - -.- _.- ------------ FINAL INSPECTION BY-------IV C .. .. .----. ... Date ----- --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Syeamore Street 814 North "C" Street Stockton, California Lad;, California Manteca, California Tracy, California ES--4-210 Revises 1.57 F.P.CO.