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je %n APPLICATION FOR SANITATION PERMIT Permit No. (Completer in Duplicator f Date Issued Application is here"y,.made to the_San.Joaquin Local Health District for a permit to construct and install the work herein described. This application isfmac�e incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------- $__S- ------N-0------ -----------ST'------------•-------------------- a - -- ----------------- Owner's Name-----------=---s�-9M.En--------------�-o- I SO - --- Phone----5t-I&--- - �11 ----------------------------------------------------------•-------------------------------'------------------------------------------- Address 1 Contractor's .,Name------------------------- =--------------------------------------------------------------- --------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms ----- Number of baths _1_____ Lot size � ____ ____________ _____________ ommunitY system Water SuPPIY� Publics stemPrivate Dept ft. r�Character of soil to a depth of 3 feet: Sand Gravel ❑,� Sandy Loam [j Clay Loam ❑ Clay ❑ Adobe ( Hardpan F]New Construction: Yes ��/ FHA%VA: Yes L] No E-]Previous Application Made: Yes E] No &I No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available wiWit,200 feet.) Septic Tank: Distance from nearest well_AON._____Distance from fou*dation_ju_ ___f____.Ma erial---�R_ _��Q_obs ------- ._ _3)('j--Y_6-. Liquid Capacity � � No. of compartments ______ Siz I' - ;. M f each line_ P ation_� ___ �'_!.-___ istance to nearest I t I' e___ _______ gg�!� Dis osal. Field: Aiumaber of lines �th pfrom found � � N/idth of trench_:•__�'7________________________ ti )- ----. -------- ----�O-- 1f.---- f• .. Type of filter material____?Q_�,�___Depth of filter material_._'___��-___ Total length__ _r________________________ ` Seepage Pit: Distance to nearest well------- --------------DiInce from foundation--------------L____.Distance to nearest lot line________._.__---_ -7 X K NGr dumber of pits----------------------Lining m'ateriai-----------------------Size: Diameter-----------------------.Depth------------------------------- _ Cesspool: Distance from nearest well-----------------Dislance from foundation_.__ ________._.Lining material------------------------____._______. •_ Li uid Ca acit als.� [] Size: Diameter------------=------- -- ---------------De fth - ' - w _ :-- --- -- - -- - p _ G P Y---------------------- 9 Privy: Distance from nearest well--..--- E_ _,_._R __-_______________._Distance from nearest building_______________________________----`--- ❑ Distance to nearest lot line--------- { -?�----------------------- -------------------- -----------• ------------------------------------------------------- Remodeling and/or repairing (describe: -----------------••-----------------------------•--•--•--- --------------•----------------------------------------------- ------------------------------------------------------------------------------ - t ------------------------ •--••--------------------------------------- - ......... that ordinances,heretate by and I have rvlesprepanda regulatioed ns Sant Joaquin Locaiwork Healthwill eDistric#n accordance with San Joaquin County (Signed) . --- ___________________(Owner and/or Contractor) Y� ------------ ------------------ ------ -----------------------------------------------------------(Title)---------------------------------------------------------------- �l � (Plot plan, showing size of lot, location o� system in relation to wells, buildings, etc., can-be placed'on reverse side). �j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--' --- DATE----- �LJ ' REVIEWED BY---------------------- --------------- DATE------------------- ---------- - -------------- - .-. BUILDINGPERMIT ISSUED-- ---------------------- --------------------------------------------------------------- --------- DATE------------------------------------------------------------- Alterationsand/or,recommendations: 1 ----- --------------------------------------�=:-------------------------------- •-•----------.-.------------------------------------------------ ____ --------------------------------------------- _! _ _ _A_NK____-_-___ _ _I -_. _____ __.__-_:_-__.______-__.._________--____T_ -e ._____________' _ __-___-__. -__-____--____________._________________---_._.____ - FINAL IN CTIO -- - - --- ' 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-9-2M Revisea 1.57 F.P.CO.