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AP i PLICATION FOR SANITATION PERMIT Permit No. / • .t"`fA y a (Complete in Duplicate) (o� Date Issued _ !/__7/�__�_ 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 Ordinan o. 549. ,. 7 JOB ADDRESS AND LOCATION . i -___,, ------------------- _!f � G L — l f L ____-•---••••------------- Owner's Name ----------------- 1` i = == ._> _x-,�✓�----------------------- -------------- Phone------------------- Address------------�-' __<1,.: -•--------------- - ------- ----- - Contractor's Name--- tc' G �= Phone .490- --------- - -- ----- 4. 0--- Installation will serve: Residence C2- Apartment House Commercial [-ITrailerCourt E] Motel El Other El Number of living units: _/'__ Number of bedrooms _____ Number of baths -r-: Lot size __•___ ___-_?< -� ---- ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4/pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No Eg-"New Construction: Yes [b�o ❑ FHA/VA: Yes ❑ No [�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub)c sewer is available within 200 feet.) Septic Tank: Distance from nearest well __p__._Distance from foundation__ �4---- --- Material No. of compartments_, __Sizer' �� 1 e/ . - . '- Liquid depth--------/ -----Ca Capacity--------- ----- - P Y ----- �c. me Disposal Field: Distance from nearest well/46-1---Distance rom foundation O` ___Distance to nearest lot line____ Number of lines______ '� Length of each line-11--_--!�_____________Width of trench_C-5K _-___•____-_•-_ Type of filter material_46 : AT--_Depth of filter material__ �-----Total length_. '"' --------- Seepage Pit: Distance to nearest well_,-:J____:-__-Distance om foundation_. `� jr' ._--•___.Dista�e to nearest lot line_________ Number of pits___/__-________Lining material___+.r ------- Size: Diameter___,_.?%3 pSr --------Depth Cesspool: Distance nearest well___ _Distance from foundation-__ _ __ __-___-____.Lining material-------------------------------------- ❑ Size: Diameteate r ------------Depth----------------------------------------------------Liquid Capacity------------•------•- Distance to nearest lot line gals. Privy: Distance from nearest well-__--_-__--__ _ _ _ _ :__ _____-_._ --_ Distance from nearest buildin ❑ - - g Remodeling and/or repairing (describe):---,-------------------------------------------------------------------------------------- -------------------------------------- ---------------------••-------------------------- -----••-•----------------•-------•------------------- ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be' done in accordance with San Joaquin County r ordinances, State,,laws, and rules and regulofions of the San Joaquin L�Health District. 1 p d (Signed) t' - - _t` ` r .t �nA�— Contractor) By:----•------ Title__. - s ------- - -------------- ��- _ _ ----------------------- -- __ _____ _ ______ (Plot plan, showing size of lot, location of system in relation ells buildin s - g , •, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / ----- °REVIEWED ------ DATE �BUILDING PERMIT ISSUE0._____ DATE--- ---` -- ----- ------ DATE------------- Alterations an /or recommendatl T _ ----- --- -- - `i� ----------- ----------- ---_------------------ ------------------- ------------------------------------------------- ---- ------------------------- FINAL INSPECTION BYE - `� Y ` - " -r Date--- SAN JOAQUIN LOCAL HEALTH DISTRi6T 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 Revisea 1-57 F-P.CO.