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APPLICATION FOR SANITATION PERMIT Permit No. ...1.. _Q.. (� (Complete in Duplicate( mom�'°�„� yy-��yy��•;p�yy '"ry^ 9 SCANNEate 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.... �./ B..l. . .-��------- Owner's Name - L : /(�ix Cr 1---- - // l �f -j- - . Phone---- - -- ------- Address. 1--k 1 pF �-�FQ/(f /L.----------- ----------------------------------------------------------------- Contrector's Name - Q.fo rrrr------------------------------------------------------------. Phone- -- ....- Installation will serve: Residence LL]" Apartment House ❑gg Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/... Number of bedrooms _S__ Number of baths _ev_ Lot size _00f4e7 Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table .40k"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3- Fiardpan ❑ Previous Application Made: Yes ❑ No [g• New Construction: Yes g?"PNo ❑ FHA/VA: Yes p—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o /� Septic Tank: Distance from nearest well_)MVI;Distance/{rom foun ation----��.___..Mater l-�_�.f _15J�� __... �� No. of compartments_.-_ ____.___Size.. (2.. _ squid depth____.!!,' 7 fi - Capacity---l��--- Disposal Field: Distance from nearest well-4/0j(5-Distance from foundation---Ae--------Distance to nearest lot Number of lines__..____..+..p................Length of each line..--7xs.._!__.__ Width of trench----- `.L....__. � Type of filter material__X.0!4tG._Depth of filter material...../ �`_.___.Sotal length.._./..�:Ld_.........._,...-----_ S Seepage Pit: Distance to nearest welIA0't{/&.__Distance om foundation...,/e - C" .,llQ ......Distance to nearest lot line..._e'f. _.... �o �f _ [L}� Number of pits_.._.G ____._Lining material. ___12.CrlLSize: Diame+er._ __-_----Depth..._.. —'_-----_----. Cesspool: Distance from nearest well---_-------------Distance from foundation ----------_ ------Lining material .._._------_._-------------------9' ❑ Size: Diameter------------------ -------- -----Depth--------------------------- ----------------------Liquid Capacity--------------------------gals . Privy: Distance from nearest well------_._----------------_-_---__---_------_-Distance from nearest building._--------_----------- _------ ❑ Distance to nearest lot line------------------- Remodeling _..._._Remodeling and/or repairing (describe):---- --------, (iLa�---- .t. -•_ _.fid' -------------------------------------'-------------•'� ' - -------------- ------------------------------------------------------------ ---------- ----------------------------------------------------------------------------- ------------- -- t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- . ....... - ---A - Qwmer-aarl�er Contractor By:--------------------------.............. off A-00----------------------------- --- ------- Itle. (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. , -------------------------------_-_"'-- DATE------ - REVIEWEDBY.------------------------------4 ------------------------------------- ------------------ ----------_------ DATE------------------ - - BUILDING PERMIT ISSUED----------------- ----------------------------------------------------------------------------- DATE---..._.... - - - - Alterations and/or recommendations:_.----------------------------------------- -------------------_'-'-----------------------_-'------------- ------------------------------------------------------------- --------------- .............---------......-------------- ------- ---------- ------------------------------------------------------- -------------------------------------------- --------------------------------------------- ------------ ------------- - --------- - -- - -------------- -- ----------------�/-...------- - FINAL INSPECTION BY:.--------- .. Date /d- - - - $ N 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 R.,4eo 1-57 F.P.CO.