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O APPLICATION FOR SANITATION PERMIT Permit No. A.l...I[— ?-.,... (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.. /V, O ,,; Rt.— JOB ADDRESS AND LOCATION.'TII� Ef''S�1/�-- - t'G ��dS� --------5=�c� .se4 ---------------------- Owner's Name----- I- C. _ ---------•----------------------- -------------- ------ �------------------------------------ Phone........................------•---, Address----7A._ _ts `�O �iT.. �f:'��.�H l `�f- 034---c1,_. GE ![X_„'---------ham Contractor's Name.. T-K1-_.� ..,,-.�[� f"_1 ._ 11 _ l !@ Phone.�.e74 Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ _Motel Other ❑ Number of living units: A__._ Number of bedrooms_.. Number of baths k�Lot size .... Water Supply: Public system ❑ Community system ❑ Private>4 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan❑ Previous Application Made: Yes ❑ NoV New Construction: Yes No E] FPA/VA: Yes F1 No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ____--Maternal---��'-----• ................... Septic Tank: Distance from nearest well_ :! _______Dis#anterfrom foundation._�sz e� ..•____.... No. of compartments__ __ Size__x_�6____---Liquid depth S ________:-.. Capacity l.?r-5 , --------- - Disposal Field: Distance from nearest welLQ _DistaXnce ro3mtfoundati n.._6_Q__�__.Distance to nearest lot line_-_ N Number of lines___s- ____ _ Length of each line___ _Q.`-yt-/, d.P.Width of trench-----a �!________-___ � Type of filter material_ _,.. 1_CC_ ____Depth of filter material____/_8'_`_......Total length•___.___!.. __4.................. __ l Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._-__,_____--_... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- RSize: 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 certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �c ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. Si ned--'�-��. •--- �.Zjkt All _( 9 ) � ---- �---�----- � ----Wuildings, ------------------------TE9k'®�.Contractor) B ---------------------•--------------------•--•----------------------------------•--------....-------- -Title-------- (Plot plan, showing size of lot, location of system in relation to well can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-- '------------------------------------- ------------------------------------ DATE------LL'_!_-Q_.•"-3-c7--------------•------- _. REVIEWEDBY--------------------------------------------------------------------------------- ------------- DATE------------------- ----• BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------- Alterationsand/or recommendations-----------------------------------•-----------------------------------------------------------•-------------------•---------------........................... ---------------------------------------------------------------------------------------------------------------------....................................................................................... --•---- --------------------------------------------------------- - -------------------- ------------------------------------------------------------------------------------•-----------...--------------------------•••--- FINAL INSPECTI BY:----- tom-- -- ---- Date----- ---------.............-......... 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 FYCO.