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7 �i N, APPLICATION FOR SANITATION PERMIT Permit No. __ r . (Complete in Duplicate) >/WS Date Issued .__-_ �`� Application is hereby made to the San Joaquin Lac I Health District for a permit to construct and install the work herein described. This application is made in compliance with County�Ordinance No. 549. ��fV1 -g- JOB ADDRESS AND LOCATION---------9-6-1----------S----- ----------`�---=--i�,E�-�------------------------------------- nn{� - A� V Owner's Name 1!'!- ��''� !_q F` Phone----------------•-------------•---- AddressfO,- K_.. � �T R-Q-P-------------------•------------------------------------- -------------------------------------•----------------------------......... Contractor's Name-----------------A15a9-F------------------ ---------------------- --------------------------------------------------- -------- Phone----------------------------------- Installation will serve: Residence - Apartment House Commercial ❑ Trailer Co 2� El Court Motel ❑ Other El Number of living units: _1_____ Number of bedrooms __l___ Number of baths -------- Lot size -_` :�_. _ 2�'©------------ ---- } Water Supply: Public system ❑ Community system ❑ Private Il Depth to Water TableYD-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam,❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS:—-7— ' " F .-1 (No septic tank or'cesspool"permitted if public sewer is available within 200,-feet.)yy� ;;77 Septic Tank: Distance from nearest well . __-__Distanc�/e from foundation-_--_ _�1_._____:Mat r�al____I•S _O! _ ___.________. t ®/ No. of compartments.-------�Z�--------Siza3_d1r4.__,. -------Liquid depth----`�-----------------Capacity ---g d--,-- i' Disposal elcl: Distance from nearest weK.5P-------Distance from foundation___/0---------Distance to nearest lot line---5--______- /c Number of lines-----------------------------------Length of each line------- of trench_.___ - _ p , Type of filter materia6------7EQ_r✓�Depth of filter material___.__1_ ___--____Total ,length________ _ __ -4_ ______________ Seepage-Pit: Distance to nearest well----------------------Distance from l f-o_.u_.nd. ation__--________._-._-.Distance to nearest lot line---_-_________-__ Depth--------------------------------- Size: � Diameter_________________.___.El Number of pits.___------------------Lining material Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- r [) Size: Diameter Depth------- -- -----------------------------------------Liquid Capacity_.-----------------------gals. Privy: Distance from nearest well___________ -----------------------------------Distance from nearest building__________._____---__-___-____________-- ❑ Distance to nearest lot line-------- -------- �. -------------- p �+ n SR S = _L ------- jlt_ r`�%------[_-�'_- modelin and/ re air n escri e):____--M.f ___SNIA1�1 ___ --•----------------------- __ ------------- -------------------------------------------------------------- - -------- --------------- ------------ --------- - -- - ------- --- -- ---------------- --- ---------------------------- -------------------------------- ' -- - ------------------- �Q--------------------------------------------------------------------------------------- F I hereby certify that I have prepared this application-and.that the Work will be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k . (Signed)..'-- - ------ -----------------------------------------------------------------------------------(Owner and/or Contractor) By=--------------- ----------------------------------------------------- --------- - --------------=-------------------- ------------------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc.,>can be placed on reverse side). r +. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -- ----------------- ------------------- ---------...----------- -- DATE------- 7'--- ------------------------- REVIEWED -------------------- - REVIEWEDBY------------------------------ ------ ;------------------------ ----------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------ --------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:__-------- =``T=--------------- F---•- --------------------------------------------•--•----------------------------•------------------------------- ----------------------•- -------------------------------------------------------------• --------------------------------- ---------- -------•---------------------- --------•--------------------------------------------------------- -----------------------------------------------------------------------------------------------•--------•-------------------------------------- ------------- ----------------------------------•------------------------------------------------•------------------------ ---------------------- ---------------------------------------------------------------- -------- ------------------------------- ------------- FINALINSPECTION BY------------------ - --------------------------------------- - Date----- ------------------------------------------------------------------------ SAN ---------------------------- -------------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---4-2M , Revisea 1.57 FRCO.