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A S(t APPLICATION FOR SANITATION PERMIT Permit No. ...��.�.1�` (Complete in Duplicate) Date Issued --- -_--- Y� 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--_tV. Q' `- - >f ------------------------------------ ---- ....-....,_ ��--^ Phone= 4 Owner's Name-------��.,55 ------- Q_1�. ..... H fc otlq-� ------ .. Address------------------ 46 ----- - -- -eG_Q � 19-9 Contractor's Name--- -------------- Vic#- --- .. - --------S .a . V .. CO----------------------------------- - --- Phone'hl., Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: .____ Nu r of bedrooms _=L Number of baths .1... Lot size -__fP. �. --_ 1 -- -------- ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table* ft. Character of soil to a depth of,3 feet: Sand F] Gravel F] Sandy Loam [_] Clay Loam ❑ Clay [3 Adobe Hardpan Ej Previous Application Made: Yes ❑ No New Construction: Yes ❑ No HA/VA:Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECT ICATIONS--" (No septic tank or'cesspool permitted:if public sewer is available within 200 feet. Septic Tank: Distance from nearest we11j10A9___.Distance frgm f undytion-__1�" __.-_--.-.-MateriaL._._��.C _...- e.e• No. of compartments- .._.__..._ Size �'_ _� _:___!.Liquid. dePth_.. d.. .__.__._._Capacity. 1 p ll;�`I.Q _Distance from foundat'on-..I__0----------Distance to nearest lot line--�_a .... Disposal Field: Distance from nearest we Number of lines__-I_--__;pp_ ---. ------Length of each line__�_Q.!_--__---•._--_.Width of trench �'�................. Type of filter material•li�Po R _Depth of filter material.....`_8____-------Total length.._...�'Q.'........................ Seepage Pit: Distance to nearest well.N14E---------Distance from foundation.. .. ............Distance to nearest lot line................. Numb of pits---I------------------Lining mate ria 1--ka-cAS-------Size: Diameter._3.3_'_"_.____.3_'_"_.____Depth...2.X................,., Cesspool: Distagt a from nearest voll-----------------Distance from foundation-------------------- material__________________________--------- Q ❑ Size:Teter.--- ' -----------------Depth--------------- -- .----_Liquid Capacity ..---_--•--gals. Privy: Distance from nearesttwell-------------------------------------------------Distance from nearest building._ -_ _-,.-____---------.____--_._. ❑ Distance to nearest lot-4�e---------------- -------- ----------------- -------------------------------- •-- ----_- -_ ------------------------- Remodeling ---• ------•------ -----Remodeling and/or .;repairing (describe):----- -------------- - ------- ---------------------------•-------------------------------........................................................ --------------------- -------------------------------------------------------------------------------------------------------------------- - --------------------------------------•--------- -••----------------------------- I hereby certify that I have prepared this application and tha the wok will be done in accordance with San Joaquin County ordinances, St a awtAnd rules and re ulations of the San Jo 'n Loc Health istrict. (Signed)-.-.4- -\\-Duh} --- !�-a--�----- v - �- ------- ---------------------------------= Contractor) By:....................................-----------------••-------......------ ---------- --------- ---- ------ ---(Title)------------------------------------------------------ (Plot plan, showing size of lot, location of system in relation to w Is, uil etccan be placed on reverse side). FOR DEPARINXN,T USE ONLY APPLICATION ACCEPTED BY...- f ----- DATE .------ REVIEWED BY -- -------- DATE _.... _. ...... BUILDINGPERMIT ISSUED............................ ----------------------------------------------........ DATE-----------•---- ------------------------------------------- Alterations and/or remmendations _ --. 1 --lix:4 -- --- ----- -----•----.... "`– .... -- --------------- . . --------------------------------------- - -------- - --- ,.--_--- - .. ---------------•-- ------------------------- •---- -- - ------ FINAL INSPECTION BY: ------------------- Date----------q- --- -----•------------------•---- 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 e ES-9-2M Revised 1.57 F.P.CO.