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4- APPLICATION FOR SANITATION PERMIT Permit No. 1" 7 (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION----------i�;//------- ----r------------------------------------ Owner`s Name-------------------- -------- 4_1-zl/------------------------ ---------------- Phone-- ---------------------•--•-------- Address - , Mj --•-•------------•--•----••-•---------------------------------------------•-•--------------------------•- 1 Contractor's Name--------- -- `J r Phone---,,a---4,% Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court E] Motel ❑ Other E]Number of living units: __-/___ umber of bedrooms __Number of baths _f--__ Lot size __-__10''__Y-___ — _f ._______--___-_-_ Water Supply: Public system Community system E] Private E] Depth to Water Table ft_ Character of soil to a depth of 3 feet: SrA Gravel E] Sandy Loam Clay Loam ❑ Clay E] Ad 'obe Hardpan ❑ Previous Application Made: Yes L] E]NoNew Construction: Yes ❑ No FHA/VA: Yes No TYPE OF INSTALLATION AND SPECT NS: _(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ptic� 4� Distance from nearest well_________________Distance from foundation--------------------Material------------------_----------- ------------------- No. _._._.__ --_-._----___---_-.No. of compartments--------------------_---Size------------------ -' .-Liquid depth-------------- -----------Caacit � __---:-_-_-Distance to nearest lot line��'__-_-___ ispo I�F!i�Id: Distance from nearest w 11 Distance from foundation__- _ � h u1 Number of lines_.___________ ___- Len Length of each line________ ff___.Width of french,--;- _ : {' I 9 ,V - - ;r Type of filter material-----_R� _Z/+ _Depth of filter material-----f�__--,__.Tota l lel�gth____- 0-----------------------7_ w Seep jt: Distance to nearest well___----------Distance fou anon---/0---------Distt nce`to nearest lot liner___ �10 Number of pits_._.__--------------Lining material_________Y_ Size: Diameter_____ _ ..-____Deptn____ ��.__-_-____-_ esspool: Distance from nearest well-----------------Distance from foundation_-- -- --.Lining materials'------------------------------------ Size: ____----.__----.----.- __-_-__-. ❑ Size: Diameter------------------------- ------Depth--------------------------------- ;---s--------Liquid Capacity----------:-----------------gals. Privy l Distance from nearest well-________________________________ _________.__Distan�}from nearest building------------------------------------_____- ❑ Distance to nearest lot line------------------------------ -------------------------------------•.--------------------------------------------------------------------- Remodeling and/or repairing (describe):------- - – -/' _�1-------- ------------------- ----- , ! `------------------------------- - -- --- --f� - --------------- -- f-- ------- --- --------------------------------- ---------•- ---------------- ---- - --- --- - ---- -- F ------- ------ - � i ---- -----�M-�-----�C --=--= ;. , --�----------=-------------------------- -------------------------------------- -------------------- ----------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 lotions of the San Joaquin Local Health District. �. _ __ ______ f!-_' _-(Owner.and/or Contractor] (Signed) DI = = = --------------- By------------------------------------------------------ ------ -------r ✓ - (Title �� (Plot plan, showing size of lot, location of system in re anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- =-------------------------------------- DATE---------------- ' REVIEWED BY------------------------ ,_f -- -- ---------------------------------- DATE----------- BUILDING PERMIT ISSUED------------------- Ult'v - DATE= Alterations and/or recommendations:- ---- --------------------------------------------------•----•--•------------------- ---------------------------------- ------------ r^ I -- 7, ---------------------------------•------ --- --------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTI - Date....._. .-O - ------- --,7- -f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wass- Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Reviseo 1.57 F.P.CO.