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APPLICATION FOR SANITATION PERMIT Permit No, 4 n (Complete in Duplicate) • 7 l�j Ju `1 Date Issued __- 44. 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--- �J_�.-----=�-•`---- .0 I��---------------------- ---------------- ,yJ l _ �+� Owner's Name /L------- ..........f "Z_ _�rAf----- -t ' -.5----------- ------------------. Phone_AP..._T�c3JL. Address l .:I-- _7' r • =- _rC [d�fK/f ----- --------------------------- -------------------------•-----•-•-------•-----------------•-- Contractor's Name------li r ,% -: 1 � ~1 �-------re,----------------------------------------------------- Phone_l?�$77 7___ Installationwill serve: Residence F�p tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ _j___ Number of bedrooms ______._ Nu t k r / -- mber of baths l Lot size w _. X�/Z- Water Supply: Public system �Commuriity system-❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe p' Hardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes, NO ❑ FHA/VA: Yes ❑ No 2 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if publi sewer is available within 200 feet.) Se tic Tank: Distance from nearest well___-"-"-LiDistanc` ,fro-- fo da ion____./ ---- Septic 1 '- J� '� 'lr p / m P - A No. of compartments-------- --�- jj------Size_4._.X'_5j_4__X _;L� _.Liquid depth--- -¢-- ------Capacity-- ---,--- Dispo I Field: Distance from nearest well..-/ 2ALrrrDistance from founda on ODistance to nearest-I t line._....__. [ Length of each line--+!` _` 1Nidth of trench__`__ w..� Number of lines � = Type of filter material___ ____Depth of'filter mate�ial----��'_________Total length_______ ________________________________ t t ` Seepage Pit: Distance to nearest well __ Distance fvgn fy9 undation__ /47-.______.Distance to nearest lot lin _ `y Number of pits------/-------------Lining material__ _ t_-Size: Diameter-----+3133�_----__Depth-_A:2 ______._________ "U Cesspool:-- Distance from nearest well__ _____________Distance from f undation--------------------Lining material_ ------------------------- ❑ Size: Diameter------ --------------------------------Depth----------------------------------------------------Liquid Capacity-1.----------------------gals. Privy: Distance from nearest well_____ ------------------------------------------Distance from nearest building------- ---___._-__________-__.___.______- ❑ Distance to nearest lot line----`------------------------------------------------------------------------------------------------------ `-------------------------------- Remodeling and/or repairing (describe)_______________' 1 ------------------------------------------------------------------ --- '- 4 ` j f ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application a d that t e work will be done in accordance with San Joaquin County ordinances, State laws, and rules gulations he S Joaq ' Local Health D' frit+. l (Signed)------ / --- - --- - -- -'f----- --- - ---------:------- -----)Owner a d/or Contractorl ---- -T---------------- i (Plot plan, showing e 0 1 , 1'cation o s em in rela 'on to wels, buildings, etc., can be placed on rev rse s e. F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------ DATE, ------------• ---------------------------- REVIEWED BY--- --------- ----------•---------- ----- - ---- - --------- --------- DATE ------------------------ - BUILDING PERMIT ISSUED---------------------------- ' ----------------------------------------- DATE - ----------------------------------------- Alterations and/or recommendations-------------------- -------------- --------------------------------------•------------------------•-•-------------•------•------------- -•---------- ---- --•-- - --•- ,. ------- ------ ------------------------ -- ------- -- ----- ------- ----------------------------------------------------------------------- --------- --------------------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------- 1 - ' FINAL INSPECTION BY:----- ---------- ------------ Date 21`�Cjr -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21M 12evisea 1•57 F.P.CO.