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42.1 0 _ I APPLICATION FOR SANITATION PERMIT Permit No. O� ' (Complete in Duplicate) Date Issued --- Application _Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------- _ ------.�_.fi, -------- u--------- ---------------------------------- Owner's Name______..__ --------- --- - Phone-- hone_4.44-j-- d.___ Address-------------------------------------------------------- Contractor's Name ott - `� ---•-- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ ' Number of bedrooms __�__ Number of baths __/� LOt size ------/_2, r____._?_'�...... �.-�________..__ Water Supply: Public system Community system ❑ Private:❑ Depth to Water Table 4V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ ' Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2--�;;N`ew Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) aiT; Distance from nearest well--__-.-_-___-__Distance from foundation___________________.Material_-_____:___-_--_-__-___________-._--______--. No. of compartments--------------------------Size................................Liquid.depth--------------------------Capacity- -------------------- I Fi Id: Distance from nearest well_________________Distance from foundation_--------------------Distance to nearest lot line__...__..._ ' Number of lines-----------------------------------Length of each line-__-------------------------Width of trench-------------------------.-_____--_ Type of filter material------------------------- Ef.7ilter material-----------------------Total length-_________-_______-_____.-_-__---___--__.- it-x-4-_Distance m oundation______ Seepa e Pit: Distance to nearest well___. _ _ /6__�___. t`�c�e,to nearest lot Number of its--.__-. Linin material---- -.__--.Size: Diameter---- ---------Depth V P 1---------- 9 p ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- 1-1 . __----__ .❑ Size: Diameter-------------------------;------------Depth------------------------------------------- ------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.______--___-_____-________-_-_-- ❑ Distance to nearest lot line---------- --------------------------------------------------- /-------------------------------------------------------------------- Remodeling and/or repairing (describe)------- -- ---- ---------------- ------------- ---------------------/_'!/___----.---- -------------------------------------------------------- --••-•--------•------•----••-•--•-------•••-•--------------•------•--- -----[ •--------- ----------------------- ------------ -------------------------------------------------------------------------------------------------------------- I hereby certi that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and4rles and regul of the San aquin L Health District. Sined �j,( 9 )---- �=f-� �-�- --------- -- -- -s-•-- �--- -9------------------------------------------ {'Awnerand-fer'Contractor) By:----------------------------------------------------------------------------------- - - --------------•(Title)-------------------- ------------------------------------------ (Plot plan, showing size of lot, location of system in relati o wells, builds gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- -------- --------------------------------------------- ---------- DATE---------------------------- REVIEWED BY------------------------------------------p---- -------------------------------------------------------------- DATE.-------------} � ------------------------- ---------------------- BUILDING PERMIT ISSUED-------------------- ------------------------------------------------------------------- DATE----I --------- -r------------- - ------ Alterations and/or recommendations:____ __._._.._..__._____,_________________________________________________ :- ------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------•---• ------ ------- __ ______________ _________ - ... ___ -_-__-_- ...... .�,.-_. _.__.._..__-_._._..f_ ____..'_._._-.___ V T._..__.__________y�- _..-_10 ._ 111 V J FINAL INSPECTION BY:.---.m------- Date--------------/ (_ 7 / ----- 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.