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�1N APPLICATION FOR SANITATION PERMIT Permit No. .- -�- � in Du licate `L r (Complete P �'1„ f,��_, Date issued .--:_�X� zay'rc de to the San Joaquin Locaf Health District for a permit to construct and install the work herein described. Application is hereby ma q This application is made in compliance with ounty Ordinance No. 544. , JOB ADDRESS AND LOCATION 2 ---------------------- - elo, Owner's Name-------Ax v _A - -------------- Phone-�/S/_S��-3 ------------ Address------------------ - Contractor's Name------------ ---------------------------- Phone-------------------------------- Installation will serve: Residence [y'-O'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ __ .z l�r�/ 1------------------- -- •Number of living units: -�- Number of bedrooms .3.- Number of baths __._--__ Lot size --,-_____- -.. --_ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -0- ft. 6k� i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan r r Previous Application Made: Yes ❑ No &`�New Construction: Yes 2e"'N'o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) �tn� Distance from foundation-_ A Material__ ! _-- Septic T nk: Distance from nearest well------------- ' No. of compartments.------.P---------------Size-_;-:4K3_b_--------.Liquid depth------ .---.----Capacity__.. OQ-- -- .--- Disp�osa/l Field: Distance from near, wellTry.... Distance from foundation__ 16 _----. Distance to nearest lot knee____--,1-_-. L7 ' Number of lines-_------3--s------------ - Length of each line__--- s-fS_-,f 0__-Width of trench--_--:-�-- ___----___-_--__ __- /� _Depth of filter material -----Total length---.-- UI------------------------- Type of filter material- Q --_---.Distance to nearest lot ii ne----_-�---___. \. Seepage Pi Distance to nearest well�l-!h _ Distancer�__Mo undation__-- } Number of pits.--.-_.3___ ------Lining material-- - -----Size: Diameter-----3-. .'.--------.Depth---a --.------------.------ Cesspool: Distance from nearest well-----------------Distance from foundation.____r--------------Lining material-------- ____---------------als. Size: Diameter----------------------------------- Depth---------------------------------------------------Liquid Capacity----------------------------9 ❑ Privy: _-.--_____---_----------------------Distance from nearest well -----------Distance from nearest b0ding------------------- ❑ ^^ Distance to nearest lot line---------------_----------------------- -------- ----------------------------------------------------------------- Remodeling and/or repairing (describe)----------------------- --------------------------------- - - _ ------------------•-•-- _----------------------------------•---------- - ----------------------------------------------------•--—------•---------------pp-------•---------------------------------------------------- q County I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ? ordinances, yfatees, and rules and regulations of the San Joaquin Local Health District. 5i ned t Owner and/or Contractor) g ------- _ _ _ _ _ � --- Title)----------�--`�----�---------- ------------------------------- By: � showingLsize of lot, loca ion of system in relafion to wells, buildings, etc., can be placed on reverse side]. (Plat plan, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------IQ7---------------- -------------------------•------ DATE , REVIEWEDBY--------------------- ------ ---------------- DATE.----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------- -------------------= Alterations and/or recommendations:-- ---------------------- ------------- g ... - ---•------•--- ---._. ------------------------------•------- �-------�1 T PT[1-5 - ---------------------------------- 6 ' �; -.-.nsn-------P_R o�P�s�------------------------------------------------- ----------------- --------------------•-------------------- �f C-,---------6---5 -s` ---------- 7 ------ ----------- ---------------------------------------------------------------- FINAL INSPECTION BY Date------- SAN JOAQUIN LOCAL- HEALTH DISTRICT ., 130 South American Street 300 West Oak Street I32 Sycamore Street 819 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO. � i