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2 w. P/ APPLICATION FOR SANITATION PERMIT Permit No. ----- (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. This application is made in compliance with County Ordinance No. 549. 101 ADDRESS AWNDCATION-- - 6, 1 ------------ ---------- Owner's Name ------------� Address --------- ------ --------- -----I------ Phone ......... . ------------ . ..... 0 Contractor's Nam -- ----- ------------------------------ ------------- e-----------IP7, Installation will serve: Residence El Apartment House E] Commercial [-] Trail ----------•------------•-----•- ----- ----- -------------------------------------------- Phon 4/ Trailer Pgurt ❑ Motel E] Other Number of living units: -------- Number of bedrooms 4-r6,L4"A 1� �X x -------- Number of baths __ ;6 ----- Lot s Water Supply: Public system E] Community system El Private . ...V---- --epv........................... Character of soil to a depth of 3 feet: Sand 0 Gravel F X Depth to Water Table/,;L ff. _] Sandy Loam [] Clay Lod m El Clay El AdobeX Hardpan Previous Application Made: Yes ❑ F1 NOX New Construction: Yes No El FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 19 ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-O-Zl Material C I e. No. of compartments_-__..__ ------ - -------Distance from foundation.__A— ------------------au------ ------------- 44- ---------- Size -:54 'S 4 ----Liquid depth- Disposal Heid; Distance from nearest well_ ----------Capacity-,2q - ----- Number of lines._--._-____ ----Distance from foundation---�L-o-------- Distance to nearest lot line ---- ------ --- 1K --- ---- Length of each line--- Type of filter material---- f of french. ----------------Wid h ---------- - ----- Seepage Pit: Depth of filter mater"'i---J-8---11--------Total length....... --- ----------------- ----------------------Distance from foundation....................Distance to nearest lot line Distance to nearest well--__.__-__ .... F1 Number of pits----------------- --Lining material------- -_ -- -----Size: Diameter—--------------------Depth-------- ------ Cesspool: Dls+ance from nearest well.__._---_--_ ---Distance from foundation ------------------Lining material ------- ------ F1 Size: Diameter-------___---------------- -----Depth----------------------------- ------------- Liquid Capacity-- ............. ---------------- Privy: Distance from nearest well.. --------- -------gais, L1 Distance to nearest lot 1�ne.. ------------ -------Distance from nearesf building------ - ------------------ ------------------- --- - ------- --.------------- ----------------------------------------------------------------- --------------- ------ Remodeling and/or repairing (describe}._-__-__..___--_-------- ----- -----------I--------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- --------------- ------------------------------------------------------------------------I----------------------------------------------------------I----------------------------------------------------- ------------------------- -- --------------------- ---------------------------- ---------------------------------------- ----------- ordinances, StO-ejaws, and rules a d regulations hat the work will be done in accordance with San Joaquin Cou-nfy- I hereby certify that I have prepared this application and that rr of the San Joaquin Local Health District. It (Signed)--------- A ----------- -------------- ------------- ------------- -------------------- -------------------- -- By:------------------- -------ZV. ---% . -------- -(Owner and/or Contractor) in- --------- (T'fl ) - (Plot plan, showing size of lot, location lofs, - em -,-e ---------------------------------------------------- i e relation to wells, buildings, etc., can be placed on reverse side), V� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY..------- --,�-- ---- ----------------------------------------------------------- DATE------- ---------------------- -------------------- -------------- ----- --------------- ---- BUILDING PERMIT ISSUED ------------------------------------------ DATE -------------------- ----------------------------- ------------------------ --------- DATE.—N', Alterations and/or recommenclaf ions: \- -- ------ ---------------------------------------------------------------------------------- ------------------------------- ------------------------------ ----------------------------------- - ----1--------- ------------------------------------------------------------------------------------------------------------------------ --------------------I-------------------- ----------- ---------- -------------------------- -------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------ ------------- ------------ --------------- ----------- --------------------------------------------------------------------------------- -------------------- -------- ----------------- ------ ------- ---------------- ——-------------------------------------------------------------------------------- -------------- --------------------------------------------------------- FiNAL INSPECTION BY:..__--__-__ a='� V- - --------- --- ------- ------ ------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California M 814 North "C" Street Manteca, California ES-9-2M Revisea 1-57 F P.M. Tracy, California