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C 'APPLICATION FOR SANITATION PERMIT Permit No. _-4,11-51- 71 CTete in Du lice+e Date Issued _____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._/140---. -- -_ Owner's Name----------------- -------- ----- (--------------------------- --------------------------------- --- Phone-----•------------------------------ Address...... -----------------------------Address-------- -----•-•--------5 ----------- - Contractor's Name ----------------------------------------------------------------------------------- Phone)� C___f _,e7 Installation will serve: Residence E--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Nur-hber of living units: __/.__ Number of bedrooms 2?�... Number of baths _ .__ Lot size ____---_S -_Y 4-� _________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _W ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D—Hardpan ❑ Previous Application Made: Yes ❑ No [B--__New Construction: Yes 21--No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-1 ±t-C!_ Distance from foundation_ d_--------MaterL__ __C___ _ Liquid clep�h -------Capacity--- -- -No. of compartments___.__.__�__.__________Size._ _.._ _ Disposal Id- Distance from nearest well ►-__Distance from foundation-40-_______-Distance to nearest lot line--------S-.__. ❑/ Number of lines_A4,'X_h_-----8��___Length of each line--- t(-__..Wiidth of trench_._._ __ _«_ __ Type of filter material--- c-�fDepth of filter material______,1$"____'_Total length_____:__ eC�____ -_ I Seepage Pit: Distance to nearest well_._-----------_---------Distance from foundation--------------------Distance to nearest lot lin __-- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h-_-----------------------------__ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-_________________.__._____________. ❑ Size: Diameter-------------------------------------Depth_-------------------------------------------------- Liquid Capacity----------------------------gals. a Privy: Distance from nearest well-------------------------___---------------------Distance from nearest building____._____.________________________- ❑ ` Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or re5pairing(describe}---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------.------ -----•------------------=----------------------------•-------•--------------------- ----------------------------------------------------------------------------------------- ----------------------------------------------------•--------------------------------------------------- -------- -------------------------------------------------------------------------------------------------------- I herebythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate I s, and rules an4 regulations of the San Joaquin Local Health District. (Signed) " " -- ---- --------- ------- ------ (Owner and/or Contractor) i y 6 Ti+le By:---------------------------------------------------- _"it (Plot plan, showing size of lot;location of system in.relation to' eils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY_-`__-^ -______ 'ry DATE____--___- REVIEWED BY-------------------- -------------------- - -------------- -------------------------------------------------- --------- DATE----------------- ------- ------------------ BUILDING PERMIT ISSUED-------------------------------------------------------- ------ DATE---------------•----•--------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------•-----------•------------`---------------•------•-------------------- ------------------ -------•----------------------------y-------------------=------------ ---'----- ---------------------------------------------------------------�-------------------------------�----A--c----K---------l-�--"--1---�---`-�-•--i-�--`--1-�-- ------------- ..... -- Yo--------- -s- - --------1NP__vcA- T- ------ � ----------- ----------------------------------------------------------- QuT--------6*----------PI7�----Las------FI-44-------"- 771 ------ ----------------------------------------- - ---- -- --- o ------------ ---------------------------- -------- --------------------------- -FINAL INSPCTION BY:. - ---- ---------- - - - - Date----- F / ------------- 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 , Revised 1.57 F.P.CO.