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i � APp}.KATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) pate Issued -------------- ---- f 3 I2-6 /, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here%d r pp Orn# Ordm nce N 549 This application is made in rice withCou� _�g� r � JOB ADDRESS A €]L CATION_ 241 ------- ---- - Owner s Name----- --------- -- ------------- ----- - s --------•----•------ ---------- ------------- ---------------------- Ph rie------------------------------------ --------- Address_...- -- ----------------- -- - - -- Phan _ �• Contractor's Name-------------------------------- ----- ---------�--- - / ----------------------------- -- Installation will serve: Residence D-`�Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number'of living units: _ ._ Number of bedrooms .,?-- Number of baths c;L- Lot size �------------------------------------------------- p Water Supply: Public system El Community system [I Private �e th to Water Table/ Character of soil to a depth of 3 feet:. Sand Gravel ElSandy Loam LlClay Loam ElClay El Adobe ❑ Hardpan C1 Previous Application Made: Yes ❑ No New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest welJ`S "---.__Distance from-foundat%on__1.4a___:-_--_.Mat�ialr ---- ,$�s �:__Liquid depth--- ��.- Capacity_1p FliNo. of compartments----- - --- -- --------Size-- _ __-- ----- q "� foundation-/0---------- 'st nce to nearest II f line-- ----- -- �3 Disposal d. Distance from nearest well__ _____________Distance from (FJ k [ Number of lines___------- ------ Length of eachI%neaZ,l!__y�-" 0-��. idth of trench______ _Depth of filter material__��'�R_-_ g Type of filter material__!_ Total length Q Seepa i Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot fine----___________- Number of pits----------------------Lining material------ ----------------Size: Diameter-----------------------Depth---- - ----- ------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter------------------------- -------------D4th----------------------------------------------------Liquid Capacity------- -------gals. Privy: Distance from nearest well_-.___._____._."---.__-------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------------ ---------------------------------------------------------- Remodeling and/or repairing (describe)---------- ------ ---------------- ------------- -------------------------------------------------------------------------- ` ---------------- ---------------------------------•------------- -----••-------------------•-----------------r-•----------------- ----------=----- --------------------------------------------•-------------------------------------------------------------------------- I herebTffe fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, aws, and r s and regulations of the San Joaquin Local Health District. Si ned Owner and/or Contractor] - ----------- - ----- ---F------ -------- - ---------- -- ---(Title} (Plot plan, showing size of lot, location of system in relation to wells, bui gs, etc., can be placed on reverse side)- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------ DATE-------- - ----------------- REVIEWEDBY It DATE----------------------------------------------------------- ------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- Alterations and/or recommendations--------------------- -------------------------------------------------------------------------"----- --- ----- FINAL INSPECTION BY_____ _ __ Date---'7.- .(O-v------------ --------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO.