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h APPLICATION FOR SANITATION PERMIT Permit Nc. .... in Duplicate) (Complete P } Date Issued Application is hereby made to the San Joaquin Local Health District fora ermit to construct an install the work herein described. This application is made in compliance with County Ordinance No. 549., �ct�� fif�� JOB ADDRESS AND LOCATION_-- / /T2 hJO�------ 'SX-� -- -� l�_� .--/ecf Owner's Na�je----�n�Ci. --- -�-t--- _�_r_-�---�`------- -�--��-'__l ---- ------------- ------ Phone.----•------------------._._.. Address------ O ........L6-.r=------ p -------••-•----------------•------••--•----•-------------------- •------•--•--•------------ --••-- Contractor's Name____1e _ srf -�,,� -------------------------------------------------------------- Phoe 2-70-1-1---•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other Pip- Number of living units:t� Number of bedrooms _.�__a__�-Number of baths _ Lot size ___ _- _____� --._ } Water Supply: Y Y Y I : Publics stem ❑ Community system ElPrivate I Depth to Water Table '7_� ft. ��"�'—/ Character of soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 12T`I�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if L 611 s7er is available within 200 feet. Septic Tank: Distance from nearest w II ----Distance from found tion Mater€al-Cl �r------------- [ � No. of compartment Sizll"_J`�M a__X&Liquid depth__�J�_`________-_Capacity -- _0A - ------------------ - Disposal Field: Distance from neare t wel/�______D€st/cee rom oeu "+ion__- +� _/_.Distance to nearest lot in�e.___._�+3 r Number of lines______ Length of each line__ ___ _ �� Width of trench--- -__-.--------------------- - -------- - ---- Type of filter materiallyr fC-_________-Depth of filter material___-�W-__________Total length-.__, ��___--__________- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________.__.._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____.__-__-_______.____.____________- ❑ Size: Diameter--------------- ------.Depth----------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well-________________________________ --------------____________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-----.- ------------------------- ------ lot Rem''o!ddelin d, or repairing (describe):___ -----�__.______' T. ------- ------------------------1------------------------------------- --- ----- ------- - -- ------- ---------------- ----------------- - A ------------------------------------------------------ ------------------------------------------------------I------- ------------------------------------------------ ----------------------------------- -----------•------------------------ -------------------------------------------------------- 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. DAY&NIGHT(Signed) ------•--Saortic T Se ra Contractor) i Y - - 1206 So. Eldorado HO 2-7046 (Title]- - -_$Y� r --- ---------------•--..�._...---------T------- -------------- ---------------------------------------- (Plot plan, itsg size of lot,IS$�'f 8R off iVstem in relati t0 wells, bttildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- --------- -----------------------------------------------•------------- DATE------- %Z7----------------------------- ---------------- REVIEWED -- -- ------ BY-------------------------------------------------- ------------._.-------------------------------------------------- DATE----------------- ---------------------------------- BUILDING PERMIT ISSUED---------------------------------- - -------------—-------------------------------------- DATE--------------- Alterations and/or recomrrEendatio --------------•--- ----------- q --I ------- - "------��---- ------------------------------------------------------------------------ ----------------------------------- - ................... ---------------- - -- ------------------------ ----------------------------------------___-------------------- ---------------•--------------------------------------------------------------------------------------•---- --------------------------------------------------------.----------------- FINAL INSPECTION BY:---- ---- ----------------------- Date---- ---------- -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revises ;-57 FRCO.