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APPLICATION FOR SANITATION PERMIT Permit No. .7./4k k_.. (Complete in Duplicate) r �' Date Issued y Application is hereby made to the SaniJoaquin Local Health District fora .permif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ` r JOB ADDRESS AND LO ATION--------- -______Il .e�` ---_ Owner's NameQ ------------------------------------------------ Phone_ Address _-Ax. .Exs� CT" -- =---------------•----_ Contractor's Name r-. Ap, ,nt � ---------------- i'honInstallation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ f J Number of living units: __!-__. Number of bedrooms _./_--_ Number of baths size ---£522 ___---1,0 ----.•-------------- Water Supply: Public system X Community system ❑ Private'❑"""pepth to Water Table -__�'��ft. "4 Character of soil to a idepth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: Yes [I No New Construction: Yes ❑ No FHA/VA: Yes ❑ No € TYPE OF INSTALLATION AND SPECIFICATIONS:j septic tank or'cesspool permitted if,public sewer is available within 200 feet.) 1 - is _ _ -" e "A n Distance from nearest,we'll_____-_--- _____Distance from foundation___________________Material_-___--- c_-__-___--.--_______--------..____._�\ No. of compartments------------- ------------ ------- Size---------------------�------ =Liquid depth-------------------------Capacity----------------•------ ` i t -. - -_t I .- / Dis I field: Distance from nearest well-, __--_-,.Distance from foundation_ Q Qista'nce to nearest lotyne___� -_ Number of lines---- --- ----------------:--- Lengthrof each :line---------- -----------r____.Widtitof trench_.T f ----------- fType of filter material----- Qjf' Depth of filter material____.___,.--Total ........._f --_-------------------- length e e P Distance to nearest well__ ------ `'".Distance from foundation_.............____ _Distance to'nearest lot line-_---,.------____ l Number of pits`_. - -_ Lining material----------------r _ Size: Diameter--------- '-------Depth-. ---------------------------•-- � „f,,, .e.. .. Cesspool: Distance from nearest well_______'_____`Distance from foundation___________________Lining material------__----_---__-__-___.---_---__. E Privy: Distance Diameter_ framr nearest w�ll-- . __ : Depth--------------. ---- -==-----=------ qCapacityci - ----- I __._ -r:Li Liquid, ❑ Distance to nearest lot-line-..._...__ D.i�ance from nearest buildin f. r Remodeling and r repairing (describej.-. --.. ---- ,,�----------- - --------------- / ¢ F ------------------7 ---------------------------N --------------•----------------------•----------------- ------------------------- -----------(/----- -.-------•------ --I here6y certify that I have-prepared this application and that the work will be done in accordance with San,Joaquin County ordinances, State laws, and u es and regul s f the San Joaquin Local Health District. (Signed) i ------------ �----- {Owner and/or Contractor) By: - 4 c -- -------- -----------------------( ) � ----- (Plot plan, showing size of lot, location o system in relation fo we] uildin s, 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--------------------------------• ---------------------------------------------------------••------------- -----------------------------•-------------...----------•----•------------------------ ------------•-----•---•--------- FINAL INSPECTION BY::[ .AX %�,, ------------- ' =----------- — Date rC SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California j _ Tracy, California _ r ES-9-21A . Revised 1-57 F.P.CO-