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FOR FFICE USP: ---------- ----- Yl ---- ---------- ----- -------7 __7_411 il 'APPLICATION FOR SANITATION PERMIT �Parmit No. -----------------------i -------------- --------------- ---------------- -------LA-7UNA .............. (Complete in Duplicate) Date Issued .....3/74/ ------------------ - W I This Permit Expires 1 ,Year From 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 LOCATIPN... ......... ............ .......!-.-. ........ Owner's ........ ...................__---------- ---------- -----------_--- ------- Phone....... J Address-------------------------- ---- ------------------- ------------------...----.....------------•-----............................................................. Contractor's Name.... 11 ... .......... ----------------------------------------------I--------M..........M-------------------- Phone................................... Installation will serve: Residence 1ET'--Apartment House [] Commercial E] Trailer Court [] Motel E] Other ❑ Number of living units: __f---_• Number of bedrooms Number of baths -,I,--- Lot size ./djk./ilv./ilv......... Water Supply: Public system E] Community s amV. ft. �ri ite Fk� to Water TableLS Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [-] Clay F] Adobe C6__-Har9dpan 0 Previous Application Made: (If yes,date--------------- No ® New Construction: Yes R--No [] FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we*7sG-.-xW-----Distance from foundation_/d.!..........Material.....--------- --------------------------------- ZP1__ No. of compartments---_2-----------------Size----- Liquid depth_- Capacit/,Z!29 T I _10 Disposal Field: Distance from nearest welleltdV_ y--.--Distance from f oundationJ.A_,"_ -..Distance to nearest lot line.,$............ up/' Number of lines---.-----------I_—--------------Length of each line_______- -_______-_.Width of trench._21'.......................... Type of filter material._.__)?o.4-----------Depth of filter material------1.0-m.........Total length..........71K........................ See ag Pit: Distance to nearest ...... Distance ffm' m frourldation---/.#.;-"*--.Distance to nearest lot line...cr�l......... Number of pits---------1_.........Lining material-----jf� ---Size: Diameter._.._...?.`....:---.Depth- ------r-2_ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material...____---__-_-__._........_._........ EJ Size: Diameter---------------__----------------Depth------------------------m-m-------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------m--------------------Distance from nearest building..---------------------------------------- F1Distance to nearest lot line-------- --- ------- -----------------------------------••-----•--•-•--•-•--- .........•--.-•-- --•M...................... Remodeling 4p ,,,,-,d/or r2escr ,pairing ibe): ---------------- .,411 ---------------------------------------------------------------------------------------------M------------M...................................................-------------M......................M------------------------ ---------------------••--------------------------------•---•• -----•......-•--•-----------------............................................................M..............M--------------------------M------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an a lafions of the San Joaquin Local Health District. .......... .. . ......m (Signed)-_--------- m---------- --------- --- --------M---- ----------------------------••-•-•----------------------------••----------••---• --------(Owner and/or Contractor) By:------ ............. ...... --------------------- -----�e- --------------------------------------------------------------(rifle).......-•--------_--------------------___------------------ 0 0 s (Plot plan, showing size ci;i�ot, cation of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY a -------•------------------- DATE....... --------------------- REVIEWEDBY---------------------------m----------------M------M-----------------------------------------M................................ DATE----------------------------------------------------••---- BUILDING .................m.............................BUILDING PERMIT ISSUED_...............................M---------------_----------....................................... DATE...............................m---------m-m----------------- Alterationsand/or recommendations:---------------------------------------___....................M............................................................................................ ------ — __ -r- -'-c --;�---------------------------------------*------------ ....... -------- ---------------M-------- L<2 ------------------------------------------------- -------------- �-o-------------- ---------------- ---------------------------------------------M----------------m----------------------------------7...................................M.................................................---•.......--•------ -- ...................-----•---------------- ------------------ ------ - FINAL INSPECTION BY:.S-'-,--- ...... .................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ER-9 REVISED 0-59 F.P.CD.2M 6.60