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"A APPLICATION FOR SANITATION PERMIT Permit No. { 1 y ! (Complete in Duplicate) z 9 1 f�� ✓ �. _ _ pate Issuedy- � O is h reby 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.,s49._ JOB ADDRESS AND LOCATION-_-.__. Owner's Name------ �J ----..�T-A_ f 5_f,, �7 Pho e-- Address---------------- / < 110 u �'_t7- . -_ - .�, -�-�- , �-r ---------------- ----- ---- Contractor's Name---------- 5. ----------- --------- -_q-�------------------------------ --------- Phone___R __.�___17_�7 ------------------ --- Installation will serve: Residence ®, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ `Other ❑ l - Number of living units: �--__. Number of bedrooms 3 Number of baths ----1--- Lot size Vyafer Supply: Public system DO Community system 0 Private ❑ Depth to Water Table.:-,54—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2g Hardpan ❑ Previous Application Made: Yes ❑ No ® 'New Construction: Yes ❑ No Q FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: FF1C'f N[,Wr O (No septic fank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---Np1&�Distanc rfr m f�u dation-_.-_-�{�-.------Material__----C,�_r----- ----------------------- No. of compartments_._- ___-Size----- _-_____------- - WL . _ Capacity ��' - , + '',;-,-�- - ,_- Distance.to nearest la lin : Disposal Field: Number of-lines rest, ell Q'1i Length of e ch line ati`. � I QtWidth of #ranch_-vim#_--____-_ 5_____ - 1 p �,. 4� t Type or filter material/ ! _- th of filter material-_.� Oki'�• � -1 Total length / �----------- W` Seepage Pit: Distance to nearest well---- r PDistanc ,from f dation_-__1Q __.___.Distance to nearest lot line_.� " 1 Number-ofwpits---_-a ,-----------'Lining maferi�. I _- -- ize: Diamet3 �r_------Dept h----s ---------------- y Cesspool: Distance from nearest well------------------Distance from-foundation_a-�-----------------Lining material----------------------_._-.�_:__::",, 3 '.,5- F ' Size: Diameter '' Depth ---------.1 3Liquid Capacity gals. . R Privy: Distance from.nearest-well----------- -------------------------------------- - � Distance from nearest building-------------------------------- Distancek ❑ to nearest lot line-_'_! — ---------------------- -' . `.. Remodeling and/or repairing describe :__ ------------------------------------- M95 Alf iv! ---------------------------- ----------------------------- --------------------------------------------------------------- --------------- -------------------------- ------•---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this ap licafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul and re alafion ;of fhsSan Joaquin Local Health District. (Si ned 9 'r (Ow and/or Contractor) ---- By: ------------ p = — ----------------------------------------------- e2 (Title s a .' ✓ 3 (Plot plan, shovkin �- ot, on of system in,relation to wells, buildings, etc., can be placed on reve se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --- DATE ------- - -- -------------------------------- -- REVIEWED l3Y_ = -------------- ------------------------------------------ DATE ---- BUILDING PERMIT ISSUED---------------------------------- ---------------------------- - ------------------ DATE - ---------------- A Alterations and/or recommendationsz-------------------_ _ ___- i. -• = --------------------------------------------------------- - - ----------------------------------- ----- - ---- ----- ----------------------------------------------------_---------- - --- ---- -- --- - --------------------------------------- FINAL INSPECTION' BY:.______ RDate -------------- -------------- ---------(- -' --------------------------------------- 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--9-2M , 111 1.57 F.P.CO.