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.. s r APPLICATION FOR SANITATION PERMIT Permit No. .__lC�_�_ � (Complete in Duplicate) 3 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 rcompliance-with County Ordinance No. 549. JOB ADDRESS AND 'LOCATION-"..- _g OCATION_..` ---- Owner's Name------ ---1�--1---�--_-�- Phone---------C--S-S----------f-------r--d--- ------- of-------------- --------------------------- .----------------- =- -Address-----------------• S ------ ----- - -- ------------- -------------------------- -----..---------------------------------------------------- Contractor's Name--------------- � --------- ---------------------------------------------------------- Phone------ ---------------------------- Installation will serve: Residencef�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___ Number of bedrooms J._ Number of baths ___/_ Lot size eA /?/-41_C? -�----------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table .//4?ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe P ❑ ❑ Y ❑ Y � Y ❑ Hardpan ❑ - Previous Application Made: Yes ❑ No New Construction: Yes P�<No ❑ FHA/VA: Yes P--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---AP ---Distance fpm founda;ion____/-V__ ___.Mate.rial___e,�� - ` _ ____________ No. of compartments------�-----------_-Size_!��_,6_-_;-4�.__-Liquid depth---z - ------------Capacity----F1?�?-_-___ s Disposal F' Id: Distance from nearest well ------- �`.--Distance from foundation---IQ-_------Distance to nearest lot _ line_ Number of lines__ ____P--_ _---___ Length of each line-__� _______r __94e______________ Type of filter material_20--^0 __- _Depth of finer material---_.lr----------Total length___-/%"____ --------------------- - Seepage Pit: Distance to nearest wellA01---------Distance f'om foundation__-J49.._-.___.D- to yce to nearest lot line__+ Number of pits__-_t�--------------Lining material_/ f• -------Size: Diameter__. , ---------Depth----P9— �'------------- Cesspool: Distance from nearest well-----------------Dista nce from foundation-------------- __-_.Lining material------_------11 - - ------ --- 171 Size: Diameter-------------------------- -------- Depth----------------------------------------------------Liquid Capacity-- -� - - --- - a ' Privy: Distance from nearest well_________________ --------------------- from nearest building___ __ ______ __-__-_-- ❑ Distance to nearest lot line --------------------- ------------ ------------------------- = • ,-Remodeling and/or repairing (describe):___-___ ---- l. J ' ------------ ------------- ,� 1. f ___________________________________________________________________________________________________________________________________________________________________________________`__3__ ---Y____Jla•----------------------- -------------•--•----------------------------------------------------------------------•----------------------------------------------------------------------------------------=--- --------('./1w`•-''-\''---------------------- S ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ..�, 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 re lations of the San Joaquin Local Health District. (Signed)- ~ _________ Contractor) By:----------------------------------------- -------- ------ -------------------------------------- -----------(Title)........ ---------------------------- + (Plot plan, showing size of lot, to ' n of system in relation to wells, buildings, etc., can be placed on reverse side). 1 F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------------------------------------------- DATE----- ----��-s---`-Sf REVIEWEDBY------------------------------------------- -------------------------------------------------------------------------------- DATE i BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE E Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------•-•---------•--------- ----------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- FINAL INSPECTION BY---------- ------ --•---------------- -- --------------- SAN --------•----SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rra, • ES-9-2 M Reviseoi 1.57 FY CO.