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APPLICATION FOR SANITATION PERMIT Permit No. 14'--31-33 (Complete in Duplicate) 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 LOCATION ._. 's" ------_a- ---------------------------------------------------------------------------------------------------------------- Owner's Name---------- �n---------------------------------------------------------------------------------- - Phone Address �� ---------- ------ Contractor's Name f ---------- ---------------1� ----- ------ - ¢----------------- ---------------------------- Phone--_,:�V0---.1_S___._27X Installation will serve: Residence a Apartment House ❑ Commercial [-] Trailer Court E] Motel F1 Other F-1Number of living units: ___.2__ Number of bedrooms ---3- Number of baths __'__- Lot size ___ xF' Water Supply: Public system ❑ Community system 51_ Private ❑ Depth to Water Table ___4r& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No RR New Construction: Yes Kj No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) rf Septic Tank: Distance from nearest well---7Za _ Distance from foundation____-/_tY__`__._.Material---- e_,.. _ J Ql No. of compartments__ 2-------------Size_._ s'X -_ Liquid depth---y_-, __:_____Capacity--- Disposal Field: Distance from nearest well__-rte ---Distance from foundation---jS"__`_--Distance to nearest lot line__s''________ Q Number of lines---------2----------------------Length of each line______-74----------------Width of trench --`'--- arti� Type of filter material____ p6.1'--_---Depth of filter material----- length____ ___'_____________________._ Seepee6e-pff Distance to nearest well----twd/_Y_� Distance from foundation-_-74 .-!_.__.Distance to nearest lot line__' FA Number of pits-----;Z-----------Lining material _-_RaC-,�----Size: Diameter-----��x_ ---------Depth----cS`.........__-_______- Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-___-___-___-____--___-__-________- ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building_____________-_____-____-_-____-_-_-____. ❑ Distance to nearest lot line-----------__- Remodeling and/or repairing.(describe):------------------------------------------------------------------ ---------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and lesAandulations of the San Joaquin cal Health District. Si ned _-_--..-_ ------(Owner and/or Contractor) - -------------------- BY: (-----------------------------------------------Title (Title) (Plot plan, showing 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-------/]- l r3 REVIEWEDBY----------------------------------------=-------------------------------------- -------------------------------------------- DATE - BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- ------ DATE---------------------- - Alterations and/or recommendations------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------- ----- --------------- ----------------------------------------------- --------------------------------------------------------------------- --------------------- ------------------------------------------------------------------------,----�----------------------------------------------- JA FINAL INSPECTION BY:----- ------ Date-------afJ T --------------------------------------------- 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 ES-9-21v! Revised 1'57 F.P.CO. f