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Permit No. ... ... APPLICATION FOR SANITATION PERMIT iK (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. r inanc Nnoo 9. _0 This application is made in compliance with County Q cli 0 > WSS7 1!14' t ............Y... --------- JOB ADDRESS AND LOCATION 574 - ------ 772�C4'94 80-1 Owrie'r's Name-,M-,,*,-A44 a#CS A r7 -------- --- --- -- - - P6 ne -W...... I (� A 77 2! _--0,4--4,--------------------- ........... Address---------------- Y-32---------W......... .......&Y�---------- ------------- pp /t7 Contractor's Name--------------------------___P_4_ --------a�------------------------------------------------------- Installation will serve: Residence F1 Apartment House 0 Commercial E-] Trailer Court El Motel 11 Other Number of living units: --- ---- Number of bedrooms -------- Number of baths -------. Lot size ----------------------------- Water Supply: Public system El Community system D Private N Depth to Water Table Z fir. Character of soil to a depth of 3 feet: Sand F] Gravel F-l Sandy Loam El Clay Loam lZ Clay E] Adobe[] Hardpan 0 Previous Application Made: Yes 0 No �, New Construction-. Yes 14 No D FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: 200 feet.) (No septic tank or'cesspool permitted if public sewer is available within I-----Distance from, iour&tion-----9----------- - Septic Tank: Distance from nearest No. of compartments__ Size/ff ---Liquid depth--- ------------------Capacity-4--.------- ------------ ---- Disposal Field: Distance from nearest weh.,-TS-------Distance from foundation___/J,5-7--------"-Distance to nearest lot lip---- ---------- 1-1-------Width of trench—�-1-4--- Number of lines__40---14 ---- --------Length of each line-e ------------Total length--- Type of filter material--y-i-IRPAI�_Depth of filter materi '& al---- Seepage Pit: Distance to nearest well/a0______-"-Distance fro rp foundation__ IS7.....Distance to nearest lot lin_'U7------ L " -eter-_313 19 Pfh--./Z---------------------- Number of pits__ ______________Lining Lining maferia 0-904 Si,e: Diameter__ , ------------De ----1ining material_____"______-"-___..__"________,"____ cesspool: Distance from nearest well-----------------Distance from foundation-------------- El Size: Diameter------------------------------- -----Depth------------------------------ ---------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building.______-_-._______________._._.______._. ❑ uilding------------------------------------------ 171 Distance to nearest lot line-------- --------------------------------------------- --------------------------------------------------------------------- ----------------- Remodeling and'/or repairing (describe):--- - ----- - ------ ....... -------- --- --------- ------------ -------------------------------------------------------------------------- -- - ------------�/ ------ - ------ -------------------------------------I------------------------I-------------- ------------------------------------------------------_----------- I-------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I-------- I hereby certify ve prepared this application and that the work will be done in accordance with San Joaquin County t" __Iles a Health District. ordinances, State laws, =d le(s)and regulations of the San Joaquin Local ----- ------AAK-14 ------------ ------------ (Owner and/or Contractor) - --------------- --------- ------ (Signed)-------------------- Y-1- By:----------------------------------- -------- ------------------A---- ----(Title)------------' -------- --- -t--------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed � n reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------"----------------- -- ------- -------------- ---------------------------------------- DATE------------------------ ----------------------- REVIEWEDBY------------- --------•------------------------------- - - ---- - --------------------------------------------------- DATE----------------I ------------------------------------- BUILDINGPERMIT ISSUED------------------------- - ----- --- ---- --------- -------------------------------------------- DATE_________q_Z-- ------------------------------------------- Alterations and/or recommendations:--------- A---- --- ----------------------------------------------------------------------------- -------------------------------------------------- -------- ------------------------------------------------------------- -------- ------------------1___1------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ) --------------------------------------------------------------------------------------------------- -------------- ----------------------------- - ----------- -- ---------------------------------------- ------------------------ ------------------------- - ------------ ------------------------------------------------------- ------ ------- Date-- FINAL INSPECTION BY-.___� ---------- ------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American -Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO-