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ulTP, APPLICATION FOR SANITATION PERMIT Permit No. ----C7- __--------------------- ( � (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. JOB ADDRESS AND LOCATION---_- ---' Owner's Name-.----__--,- - f� --------- _ilj_ . --/.. ----------------- ---------------------------------_ Address '� n _ Pha e' Contractor's Name------ - ----------- -------- -r-ve er" --------------•---•---------•----•---- ------------------ Phone^ Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of livingunits: _ _. ❑ Other ❑ - Number of bedrooms _ �- Number of baths /-_ Lot size --_- ` Water Supply: Public system Community system ❑ --------------- Private ❑ Depth to Wafer Table --V ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes El No 5( New Construction: Yes ❑ No FHA/VA: Yes ElNo TYPE OF INSTALLATION AND SPECIFICATIONS: - (I$e se'Ptic tank or cesspool permitted if public sewer is available within 200 feet.) epfic , a+ak(L.� Distance from nearest well__-_________.-Distance from foundation-- ------------_Material-__-__.___. ------------ ------ �� No. of compartments Size Liquid depth----- "Fie s - -------- Capacity------- Distance from nearest well-_�,i3 Distance from foundafion____ ! +� Distance to nearest lot line_-_ �( Number of lines_---------/!� ..---- - - - --Length of each line--_--- - - -- -,-_-._ Width of trench.__... Type or filter material__--_.__(�'� t/�,Depth of fitter material- Total length--.-----2_.7--7------------------------ Number ------- -- Seeps e Pit: Distance to nearest well---�� i - ._ � QA47_-_Distance from foundation_-- jV-____-__Dista c to nearest lot line.-_i/�� Number of its f .� �, �-___--• p --------------L;ning material---- Q-[' - p /�. --- Size: Diameter-----�=�-- __--De to -- -_S_________ _ ____ Cesspool: Distance from nearest well_----____--_----Distance from foundation_____________ P ❑ Size: Diameter- ---- ----------- -----. Lining material--------•-------------- - - ----- ---Depth- - ---------------------------- Liquid Capacity -------------- Privy: Distance from nearest weli------------------ -- ----------------------------gals. ---------- Disfance from nearest building Distance to nearest lot line_-.--- -- g- -- - - ------------------------ ----- - ----------------------------------------------------I--- ----- --- --- ----'---�- ---- - Remodeling /or repairing (de ibe):. - --- and -----� ----------- •��' 't�L_ Eke: U �----- „ - -- ------- ` ----- ---------------•--------------------------------------------- - ---------- ---------------------------------- - ------------------- 1 hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and ru s nd r gufatioLIK-of ff e San Joaquin Local Health District, (Signed)------------------- -- y _.- Owner and/or Contracfor) ------------------------- (Plot plan, showing size of lot, location of sysfem in relation o lls, buildings, etc., can(b'el placed on raver side). ti ` - --------- FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY_.-- DATE--- - -i. ---- ---- PERMIT ISSUED - --------- ---------------- BUILDING -------- DATE-------- ----------- Alterations and/or recommendations---------------- DATE------- -- ------- --------------- ---------- ------------------------------------------------ - -- - --- ------------------- -- .a• .. --- ------ -- FfNAL INSPECTION BY:.----- �---- --•- �-- - - ` - -�---`.'---- Date ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockfion, California 132 Sycamore S+ras+ 814 North "C" Street Lodi, California Manteca, California Tracy, California ES--9-2M . Revises 1-57 F.P CO.