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+ 313 / APPLICATION FOR SANITATION PERMIT Permit No. .-e__________________ (Complete in Duplicate) f S 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, 5449, JOB ADDRESS AND LOCATION__ ------- _i2.-_____� r Owner's Name---------------------- ---- ------, ---- - Phone-- . . � _ -- ---- ---Address--------------------------------- Contractor's Name D ----------- Zo v r -- -- Phone--_1 - 5G f4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1--- Number of bedrooms _? Number of baths _1.___ Lot size -------- "e-------- -- Water Supply: Public system aj/1 n munity system ❑ Private ❑ Depth to Water Table _Y'o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam elo lay Loam E] Clay ❑ Adobe ' ardpan F]Previous Application Made: Yes F-1NoEg,- rvew Construction: Yes 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 well_______Distance from foundation_-__ �.-------Material----- No. of compartments------? Size__._�4._k__Y_o.___F_iquid depth------Y./_•t _------Capacity----- ------ Disposal R-91d Distance from nearest well_�'D-------.-Distance from foundation----4 _.____Distance to nearest lot line---'__�__.___ Number of lines__________j---------------------- �.'' ______Length of each line__,_-__. __ Width of trench____c � �____ _ r Type of filter material _____ ___-Depth of.filter material_.�__�_.'_____.___-Total length____ Seepage PDistance to nearest wefl__1 ______.___Distance from foundation- .___.Distance to nearest lot line_��_______ Number of pits----I-----------------Lining material__ Size: Diameter------3_; .' ___Depth____ -fir_------------------ Cesspool: Distance from nearest well--------------_Distance from foundation------------------ Lining material-------------------------------------- El Size: Diameter---------------- --------------------Depth----------------------------------------------:-----Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well__________________ ___ _ _______________________Distance from nearest building-_-,------------------------------- q� , ❑ Distanceto nearest lot line---------------------------------------------- -------------------------------------------------------------------------------------------- Q Remodeling and/or repairing (describe):------- : - �S' '. -------------------------------------------- -------------------------•------------------------------------------------------------------------------- ---------------------------------------------------- --•----------•-------------------------------•----------------------------------•-------------------------------------------.-_------------------------------------- •-------------------------------------••---------•--------------------------------_ -.---------------------------------------------------------------------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County \r ordinances, State laws, and rul s and regulatio of the Satt-Joa n ocai Health District. N (Signed)---------------F-------- - --- -------f�` = ------- By - -------------��1 -----------------------------(Owner and/or Contractor) B :-------- --------------------------------------------------------------Title - y ---------- - -, -- -------- ( � }------��.l�heg..rte-------------------------- (Plot plan, showing size o lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). L FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- ------------ - --------------------------------------------------------------- DATE-=----------------- REVIEWEDBY---------------------------- - --�.------------------------------------------------------------------------------- DATE__ _--------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE-----W�------ Alterationsand/or recommendations:--------=-----------------------------------------------------------------------------------------------d ---------------------------------------------- - --- ----- ------------------ ---- -- ---------------------------I------------------------------------------ -- - - ------------------------ - --------- ----------------------------- - ------- ----- --- .,� -- -__-_:-___._----___-___________---_-__--__-__--__-__________----_____---____-__--------___.__-----------_ --------------- ------ ------------------- ---------------- ----------- -------------- ------ - ------ ------------------------------------------ ----------- ---- -------------------------__._ b - / Date FINAL INSPECTION BY------- --- --- ----------------�._ SAN JOAQUIN LOCAL ALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES--9-2M Revised 1-57 F.P.CO.