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APPLICATION FOR SANITATION PERMIT Permit No. ./ (Complete in Duplicate) / Data Issued Application is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein e tri ed. This a plication is made in compliance- with County Ordinance No. 549. E • JOB ADDRESS AND LOCATION._ '� Owner's Name______—T t 14, PO� � ( - - t - ..t----------- - - -------S-. ----------------------- % ---------- .90 0 a f + T � - Phon -�Contractor's Name e-`3--`-��' _- --- Installation will serve: Residence .A Apartment House Commercial p ❑ ❑ Trailer Court ❑ Mo el ❑ Other.,. Number of living units: __'_____ Number of bedrooms -------- Number of baths ---t Lot size -- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft, Character of soil to a depth of 3 feet: Sand ❑... Gravel ❑ Sandy Loam ,Clay Loam [-] Clay El Adobe E] Hardpan E]Previous Application Made: Yes E] No New Construction: Yes E] No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-_ 1 {�__Distance from foundation__ __Q of __________.Mat`erial___. _ _ -------------- No. of compartments-----2�----------------Size-+:�.�_�P1�L�{ej�__Liquid depth--- 4�__�r__.____Capacity--- �`�-(�-��' Disposal Fi Distance from nearest well-#,5�Q_`-Distance fr$m4f poundation----L!- -_�-----Distance to nearest lot line__/40_- Number of lines_________ __ __________Length of each line--e-Z) ------------Width of atertrench--�.fj, ' ---------�- Type of filter mialGr_____Depth of filter material___� ________Total length-------------------------- __Q___-__ 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__---__..___._______---_-____-__----. h ❑ Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----- ---------------------- ---------- Rem --------Rem*h, nd/or repairing (descr':be):---4) ------_-----__ ------------- ie +�. l ------- -- ----- - ----------- ----•---- -- ---•----•--- -- CILr7E-11 °- = - •---------- - - ------------------------------------------------------------•-------•--------------- = I hereby cerci§ at I have prepare applica nq Y and that the work will be done in accordance with San Joaquin Count ' ordinances, State laws, and rules an re lations of f e San Joaquin Local Health District. (Signed)- -.8--y---- --------:& - -- ° ------------------- {L�ww�l�ji! Contractor By:------------------------------ •---••--------------------------------- ---------------------- ------------- ------ ----(Title)---------------- -------------------- (Plot plan, showing size of lot, location of system in relation to,..' IIs, buildings, a ., can be placed on reverse side). FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY-------- DATE---------------------E REVIEWED BY ----- - `: DATE------ DATE------f BUILDING PERMIT ISSUED-------- f - ( r Alterations and/or recommendations:---------- ----------- ------------------------------------------I------,--------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY-t- --- -X e ------------------------- Date--- '^f_6 SANr%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 , Revises 1.57 F.P,CO.