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1�ry c� APPLICATION FOR SANITATION PERMIT Permit No. O (Complete in Duplicate) 7/ . Date Issued ____1� /w Application is hereby made to the San oaii al Health District for a permit to construct and install the work herein described. his applicationis made in compliancernfy Ordinance No. S49• JOB ADDRESS AN LOCATION -- ------- -- �----= ------------------ ------------------------- --------------------------------- ` t �•-� ��., "fir V �. :,. - � -----------------�i-------�--��_-- -- Name-'--- '«'�«l r �. .za�.y� -- ------------------------------- Owner's :. Phone -� t.,f Address -----------•--------------------------•------------------------------------------------------------ -----------------••------------ ----------------------------- Contractor's --------•-------- --------- i ,•„,, _ Contractor's Name= v --• r x ' ` --- {------------------------------------------------------------------•-•-------- Phoneme-----1.37s., ----- Installation will serve: Residence 'Apartment House I] Commercial ❑ Trailer Court ❑ Motel /0 Other ❑ Number of living units: --- __.Number of bedrooms Number of baths ____-�__ Lot size �__ ___ ____,_.. __kd✓�-______________ Water Supply: Public system �Community system 0 Private'[-]" -Depth'to*Water Table-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ "=Clay E] Adabe Hardpan El0 -... Previous Application Made: Yes ❑ No New Construction: Yes-O/ es No ❑ FHA/VA: Yes ❑ No -TYPE OF INSTALLATION AND SPECIFICATIONS:, , A .(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well________________Distance from foundation--------------------Material __-________.___-________________._____________._. } No. of compartments---------------------------Size--------------------------------Liquid depth-------------- Capacity Disposal Fi -t: Distance from nearest well__-___}_______`-_Distance from foundation--------------------Distance to nearest lot line____________.-__. Number of lines--------------------- ' ------------Length of each line------------------------------Widtk of french------ Type ------------- f ----------- fr, F Type of filter material_____ ____________--__-_Depth of filter material_____________________Total length__;._______________________ % .Seepage it: Distance to-nearest well_ 1� --Y ____Distance from f(Tndation_` ' ' �� i - Number of its____--I--_____--__:__liningmaterial___ ; Dcst�ncetonearest lot ine_•p Size. Diame er---3C.)-------------Depth-- - e---------_------ I Cesspool: Distance from nearest well-________________Distance from foundation------------------- Lining material______________-_-______________•__-. Gq� ❑ ' ) t Size: Diameter------ -------------- -- ---__:De,pth------=i--------------------------------------------. Liquid Capacity------------------- ------•gals._.-. L r '. -Y.. :, -� 'rivy: "'-Distance from nearest well______________--------------------- Distance from nearest buildin Y ❑ * Distance to nearest lot line-----------------------------------I ----------------- - -- ----------------------------------- ------------------------------ -------- Remodeling and/or repairing Idescribe):----------' _r t - _ '�A4 r _l k______ -_ ____________-______________"_-_____ __°_ t _________________________________________________ ------------•---------------- --- I hereby certify-that.I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. - +-� (Signed] - - - ---- -- - - - � - � - = - - �- - (Owner and/or Contractor] ------------- ---- �Y�----------- ---- -2.-- . - 1. x± �Ti+le) = � f� 'I t� .k�_ . ---------------------------------------- (Plot plan, showing size of o , location of system in relation to wells, buildings, efc., can be,placed on reverse e).. FOR DEPARTMENT USE ONLY .. - .._ APPLICATION ACCEPTED-BY_.., _ - = - ----------=------------------ - �-- REVIEWED BY------------------------------- . -------------------- -- DATE i ---- -- --- ---------------------------------- BUILDING PERMIT ISSUED----------------------------- --------------- - DATE --------------------------- ---•-------------- Alterations a r reco endations:-•_-_- � -G - 6/ ---- - - ----.------ t -----------------------------------------------.r,�..Q.rY , = - FINAL INSPECTION BY:.1 --- ------------- Date---------�<" f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California � ES-9-2M Revisea 1-57 F.P.CO. f