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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application' is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the work herein described. This application is made I- in compliance with County Ordinance No. 549. +9J1,1 -, UOS 1�- - 4-5-- JOB ADDRESSA P-4,0CATION__WO-jaA20-13,11-114m, - -- --V. 'V� _7 Owner's Name -10-- ------ Phone_f,,_2---------0-(7--- ---------- --------------------------------------------------------------------------- Adclress___�.Z --- --------- ---------------------------------------------------------- ---------------------I-------------- .... 7e "-" 7 4 - ------ ------ --------- --------�4 C�e ------------- do -------- -- -------U.9 __ —---- ----------------------------------------------------------------- Phone./ `- — Contractor's Name .. . .. ----------- 47� �l Installation will serve: Residence P"'Aparfi-nent House [-] Commercial E] Trailer' Court F-1 Motel F] Other 0 '1�. I A Number of living units: Number of bedrooms Number of baths _/. Lot size ----1!e�R----4elol�_ _ �---------------------- Wafer Supp Pub EjPublic sysfem ' . Community system Privafe.[elDepthrto Water Table 4-4- ft. Character oft soil to a depth of 3 feet:' Sand El Gravel El Sandy Loam El Clay Loam E] Clay E] Adobe E] Hardpan -1 Previous Ap 11.p licafion Made: Yes 0 No 9----New Co:nstructi.on. Yes E] No FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or''cesspool permitted if public sewer is available within 200 feet.) epti Tank. Distance from nearest well-----------------Di9tance from foundation--------------------Material--------------- ------------------------- ------- No. of compartments--------------------------Size-------------------------------Liquid- depjh--------------------------Capacity----------------------- Disposal Eel Distance from nearest we]_*SP.........Distance from foundation W'�.........Distance to nearest lot line---- Number of lines-------- _________________--Length of each -------------- Width of trench--_07 v ------------------ rT1 Type of filter materiaL%V1415A44.epfh of filter material------ .________Total length------------ -------------- Seepag Pi Distance to nearest weT_/."_�------Distan'c' e from f"nd ffionAl Distance to nearest lot line------ Number of pits------/------------Lining materialo?_kZ/_0 e: Diamefer-----_-5_3......Dept h----d--S—--------------- Cesspool: Distance from nearest well----- -----------Distance from foundation--------- ______.Lining material__--,_____.__________.______-- Ej Size: Diameter--------------=- -------------------Depth------- - - -----------------------------7 ___-_-_--_--Liquid Capacify- --------------------------gals.3 Privy: Distance from nearest well---------------------------------------------------Distance from nearest building--------- -------------------- ------ --- F-1 Distance to nearest lot line--------------------------"--- --------------------------------------------------------------------------------------------------------------- V Remodeling: and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------I., ---------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------i 1,1:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ f ---------------------11----------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ;k,%- ly ordinances,q,, afaws, and rules and,regulations of the San Joaquin Local Health District. - 1 1 1;, 11-1 TI: (Signed}--_.--- . ------- Owner and/or Contractor) --------------------- ......-1------------------------ --— -- --------- -------------------------------------(Title)------E-io - -------------------------------------- By:_A! .1 (Plot plan, showing size of lot, location of system in rela4ioA to wells,,buildings, etc., can be placed on reverse side). A FPR-D-EPARTMENT USE ONLY of APPLICATION ACCEPTED BY.- -i&k------ --------- --------------------------------- DATE----- REVIEWEDty------------------------------------------------------------7--_--------------------------------------------------------- DATE----------------------------------------------------------- BUILDINIG PERMIT ISSUED-------------------------------------------------------- —-------------------------------------- DATE------------ Alterations PERMIT recommendations:--------A----------------------------I--------------------------------------------------------------I---------------------------------------------------------- -------------------- --------------------------7------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- -------------------- ----------------------------------------------------------------- ----------------------------I------------------------------------------------------------1---------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- -------------------- --------------------------------------------------- -------------------- --------------I-•-----"------ ------------------------------------------------------------------------------------- PECTION BY: - FINAL IN - -------------------- Date-- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sout American Street 300 West Oak Street 132 Sycamore Sfreat 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Reviseci 1-57 F.P,CO.