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3`, _ np L'� ` APPLICATION FOR SANITATION PERMIT Permit No. _11 0_4 et (Complete in Duplicate) C Date Issued ___��!o_�S`- rR - .CIO-. El-�lsl :: D 0 - � 7Z- azo--zk Application is hereby made to the San Joaquin Local Health District for a permit to construct and in a the herein scribed. This applicafiori is made in compliance wit County Ordinance No. 549. 11 JOB ADDRESS AND LOCATION_..�, c Owners Name-------- ------- -- -- ------------ -----.-�,P one---� A - _ Address. �i�f R - ,�-- - Contractor's Name - - ------ ------------------------------------- Phone. Installation ill se Ie: Resunits: xn A artmennf House p Commercial E] Trailer Court ❑ Motel Other ❑ [C P ___ Number of rooms_ Number of bafhs _ Lot size _ G - ------------- f Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table .�e�ft, Character of soil to a depth of 3 feet: Sand ❑ G.rAvel_❑, Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ullardpan ❑ Previous Application Made: Yes ❑ No FT00_NewfG6nstruction: Yes P""No ❑ FHA/VA: Yes �io ❑ TYPE OF INSTALLATION AND SPEC IFI CATIONSc' (No septic tank or'cesspool permitted if.public sewer is available with` 200 feet.) ! Septic Tank: Distance from nearest well___`—___Distance from four atfon___� �-------.Mahal ---� � - _---_---- - ANo. of compartments----- p Liquid deph _ Capacity-----------Size .r / t Disposal Field; Distance from nearest well_- Distance from foundat'on__ � Distance to nearest lot line__�_--______ Number of lines--- ___._._'_______.___-��L-ength of each line_ �_ Width of trent k Type of filter mat ri -al____----_'--------------- Depfh of filter material-�____ __ -___Total length__ �j j Seepage Pit: Distance to nearest well______1________ Distance from foundation -------------------- to nearest lot line-_.______________ 1 ❑ Number of pits.---------------------L hing material-� _` " � ize: Diameter______________ -.. ------ ------------------------- '`1 Depth q Cesspool: Distance from nearest wellr-___.____,-----Distance from foundation___' _____________Lining material__-----___________.__------_________- ❑ Size: Diameter depth ----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------'__ __.___- ________-_.--- Distance from nearest building i ❑ Distance to nearest lot line___._�_________________________ -------------. -------------------------- ---------------------------------------------------------- Remodeling and/or repairing (describe):----------� 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 ales and regul tions of the San Joaquin Local Health District. (Signed)----------------- ----fOmme=*mtror Contractor] BY -------- ------------- ---------------------------------------------{Title)------ ,(ow- - ------------------------------- (Plot pan, showing size of, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ ..FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------------- ---------------------------------------------------------- DATE REVIEWEDBY---------------------------------------------- -------------------------------------------- -- - ------. DATE -- ------------------- -- -----------------------------BUILDING PERMIT ISSUED-------------------------------------------------------------- ------ DATE. -Alterations and/or recommendations:--------,------------------------------------------------ - ----------------------- ----------------------- -------------------•- --•-------------:----------------------- ---------------------------•-------•------------------- ------ - 7------------------------ I -------------------------------------------------------------------------------------------------------------- ------------------------------•----- ------�/--- �---------------------- ----- -- ----- ----------- ----------------- FINAL 1NSPEC� BY- - -- ----- ------------ Date--.--- ----- �7. --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street' \32 Sycamore Street;:; j. A ,1814 North "C" Street Stockton, California Lodi, California Alanfeca, California vTracy, California E5-9-2M , Revises 1.57 F.P.CO. `