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APPLICATION FOR SANITATION PERMIT Permit No. I•aj! (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp p with County Ordinance No. 549. This application is made in compliance w . JOB ADDRESS AND LOCATION--------------- --------------------------- ------- -------------------------------------- --- ------ - Owner's Name--------_L/1.1_L------ --------------------------------------- Phone------------------------------------ ---------- -----------------------------------------------•------------------- Contractor's Name . , ----- -- ----- ------------- Phone.5W.------ --- - -- - - -- --- Installation will serve: Residence [ A rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _-9_-- Number of bedrooms -` _ Number of baths ---I— Lot size ---7�-JJS ------------------------------ Water Supply: Pubiic system ❑ Commuriity system R4--frivate ❑ Depth to Water Table _v-ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Uj--<ardpan ❑ Previous Application Made: Yes ❑ No P---N—ew 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 well__AAPP, 'sta�r ,e from f ur dation--.-./d- -__--_.Material -------- -----Size-_i!!`�](S-x ------------Liquid depth------�f- --------------Ca acit f No. of compartments----------- --------- P y-�-a� `""� Disposal Field: Disfance from nearest well__AIVAle_.Distance from foundation_-fQ' ------.Distance to nearest lot line- --------- ❑ Number of lines-------------2.-----,-,---,(, -----------------Length of each line---------- ----------Width of french ------------------ Type of filter material--- Z'5b -11-----_-Depth of filter material----$...............-Total length---... -V------------------ /_-_-.- S � Distance to nearest well---/V6&-�e--___Distance from foundafionr --------Distance to nearest lot line-S-----___-_ \ Number of pits-------- --------Lining material__----_ 6 - -.Size: Diameter-----I-7----------Depth-----------,S7�-------------- Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material-------------------------- s. El Size: Diameter------------------------- ----------Depth------------------------------- --------------------Liquid Capacity-------------------------- gals. Privy: Distance from nearest well----- ---------------------------------------------Distance from nearest building------------------------------------------ Distance -----------__------- __-_-------------- Distanceto nearest lot line--- ------------------- --------------------------------------------------------------------------------------------------------- . Remodeling and/or repairing {describe}--- --------------- ------------------------------------------------------------------------------------------------------------------------------------- WI ------------ ----------- -- - --------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 7 ` �Y� {Owner and/or Contractor) (Signed) /-- ------ - --------- ---------------- -- ----------------�-------------------------------------(Title)------04!7-e-e ------- ------------------- -------------------- (Plot ---------------------------•------ ---(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY F ------------ APPLICATION ACCEPTED BY----------------- -------- -til k �vv------------------------------------------------- DATE I� � REVIEWED BY----- -------------------------------- ------ -------------------------------------------------------------------------- IDATE-------------------------------------- - ` BUILDING PERMIT ISSUED—---------------------------- -------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------- ---------------------------------------------------------------•-------------------------..--------------------------------------------- -----------------------------------------------------------------------------------------------•------------------------------------------------•------------- - -------------------------------------------------------------------------------------------------------------•-------------•-------------•--- -------------------------- - ------------------------------------------------------------------- FINAL INSPECTION BY________ __ ___ ________ _' Date------ )-Z-- J-Z-- `. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Streat 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO. t