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ly, APPLICATION FOR SANITATION PERMIT Permit No. k (Complete in Duplicate) Date Issued --- A or erem d T�plicationis hereby made to the San Joaquin Local Health District for a permit to construct and install the work h *. des 1 71. 7 er _7 ;�, �4t, application is made in compliance with County Ordinance No. 549. C�Z2? 0 0ho—Z -------------------------------- JOB ADDRESS AND LOCATION-4y-- -- ------------AV----------- Owner's Name-------- - - ------------------------------------------------------------------------ --------------- Phone_-•------------------------------ Address--------------- ------------------------------ Address---------------- --- - ------------------ ----------I--------------- Contractor's Name-------- ---- ------------- Phone----------------------------------- Installation will serve: Residence ®Apartment House E] Commercial E] Trailer Court E] Motel E] Other ❑ Number of living units: 1 Number of bedrooms _-F Number of baths -;2-- Lot size --- -------------------------- Wafer Supply: Public system El Community system g--Private [] Depth to Water Table "ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam 21"Clay [:] Adobe [:] Hardpan E] Previous Application Made: Yes F] No �ew Construction: Yes g1Qo ❑ FHA/VA: Yes [�No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation____��-------Material------ No. of compartmenfs..--2--.- Si.e_J ._lX----/W---Liquid cleP0 --- ----------------Capacity---2?&,P"g9P Disposal Field: Distance from nearest well___..__"'"___.._Distance from foundation _______Distance to nearest lot line__ -------- Number of lines-------------------------------Aengfh of each line.......1�0---------------�Wicl+h of french--- - k6:�----------------- Type of filter material_/L Depth of filter material__/10__�.........Total length-------A__�0..11------------------ Seepage Pit: Distance to nearest welf----------------------Distance from foundation--------------------Distance to nearest lot line__.____________._ 1771 Number of pits----------------------Lining material--------------.--------Size: Diameter------------------------Depth-_----------------------------- Cesspool: Distance from nearest well---------------—Distance from foundation._._---__-__-- --- Lining material--------___.---_ _.-_---_- ❑ aterial------------------------------------- El Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________________________.___.___._. ❑ uilding----------------------------------------- 171 Distance to nearest lot line------ -- ----------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------W&441) ----------- -------------------------------------------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------- ---------------I------------------- ........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�ancl reg' ull tions of the San Joaquin Local Health District. e�dti -- ------- --- ---------- -------- -------- (Signed)------------------ -------- -----------I---------------------- Contractor) By:---------------------- -------------- --------------------------- ----------------------- - (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on neve d FOR DEPARTMENT USE ONLY DATEV---------------------------------------------------- BUILDING I----------------------------------------------------------------- U' REVIEWED BY------------------------------ -- ------------------------------------------------ ----------------------- ------------- APPLICATION ACCEPTED BY ---- DATE V---------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE Alterations and/or recommendations:------------------------ ------------------------ ---- --------- :71----- - ----- A.-�_ ---------------------- _4 4&�-_ ------- - -- ------- ---------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------- � � ------------------------------------------------- --------------------------------- ----------- ------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:------- Date--. ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-1-2m Reviseci 1.57 F-P.CO.