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5 APPLICATION FOR SANITATION PERMIT Permit No. .r9 o......... ' (Complete in Duplicate) 42j DateIssued 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 "" �----- Owner's Name—,*-t--_-_ ! r } I jr ---- -- - - - Phone Address---------- __. �" "" "". �'�-1 ��-'` Contractor's Name---- ? - ------- Phone----------------------------------- Installation -=--------------- -Installation will serve: Residence & Apartment House E] ommercial E] Trailer Court E] Motel�❑ Other E] ' Number of living units: ---(.}}__ Number of bed rooms'-�___ Number aths.._1--_ Lot size , ._t7___x. _�?� 1 Water Supply: Public system El Community system E] Private DeZClay, o Water Table -------- ft. Character of soil to a depth of 3 feet: Sand .- Gravel ❑ Sandy Loam Loam E] Clay ❑ Adobe Hardpan F] i Previous Application Made: Yes E] No, New Construction: Yes De'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: `(No-septic tank or cesspool perinitted`if pub issewer is available within 200 f6a.') R � ,� e Septic ank: Distance from nearest welf,p_ -----Distance-from foundation�O-- -----:.Material-_ h �y 14 No. of compartments_.__ q__ + Size--------------------------------Liquid dep4h _._. . ..<-.----.---Capacity__. Dispos {`Field: Distance from nearest welhlDistance from foundation�/i _._ Distance to nearest lot I,I,ne �-. w Number of lines______.___. __ _- -Length of each line------- 4? Widfh of trench--- - -___ T. /, t� ,� -------- Type. of filter material--. `�w� epth of filter material_- Total length--------------I. 10 -_--__------ 'See a it: Distance to nearest ell__ 149 -------Distance from foundation ._.APO_. _.Distance to.nearest lot 'ne; ..._ Number,of pits____ ____._ Lining material_KQ_C�i____Size: Diameter ft_*w.X_�_Depth_.__ ---------------------- t Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material.:...___...____.-___.._.___;.._._._.\ ' ❑ Size: Diameter------------ -- -----.Depth--------------------------------------------------Liquid Capacity-.----- --------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building'---------- \ tV ❑ Distance to nearest lot line___..._ .____.._.. ''' i v -- ------ ___ ------ Remodeli gVin,/or repairing 4'describe:---- -- �-�"'' ------------------------------------------ ------------------ t --------- --- ......•...... ...... .. ' . '1 = --- ------ ----------------------------------------- - - ------------------------------------------ =---=----------=--------------------------------------------------------------------------- I I hereby certify that I have prepared this application and that the work with`be done in accordapce with San Joaquin County ordinances, State laws, and rules a egulations of the.San Joaquin Local Health District. l (Signed)?Lwin '4--� -'' ------------------ -- = ----- --------------------------(Owner and/or Contractor) By ----- ------ ------- - ---- --- - ----- ----- ----------------(Title)---------- - -------- - ----- --- -------- (Plot plag size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----------------------------------------- ------ DATE ---•-- REVIEWED BY-.. l " ------- = DATE_41" ------------------------- - BUILDING PERMIT ISSUED----------------------------/ - --- ------ ----- -t ----------- DATE- -- --- •-------- --- Alterations and/or recommendations:_....._ �-----. : �� see -. r --••-------------- ---- ------------------------- t -- ------- _-- - -. . _ FINAL INSPEC = a �� Date -- ---� -------------------- *---a,--- . ee SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 130 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 Revised 1.57 F.P.CO. f �q