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APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) Date ..4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fhe.work herein'd'o:§c,ribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION -------- - --------- ---------- - - ----- Owner's Name------------jj�----------- k19e.) ------------------------------ -- ----------------------------------- ------ Phone Address--------------Z , -)Vvrri Contractor's Name-------------- - Installation will serve: Resiclence ,V\ Apartment House F] Commercial F1 Trailer Court [:] Motel Ej. Other E] Number of living units. -1---- Number of bedrooms Number of baths ---L Lot size -------�;, A---' ------------------- Water Supply: Public system Community system F] Private E] Depth to Wafer Table -3� ff. h irl Character of soil to a depth of/3 feet: A Sand E] Gravel [] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan El New Construction. Yes ED No FHA/VA: Yes [:1 N o Previous Application Made: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Aepf' an Distance from nearest well_________________Distance from foundation------------------- --------------------------------------- No. of compartments-------------- -----------Size-------------- -------------------Liquid depth--------------------= Capacity `isp1 epO--------------------isp1 field: Distance from nearest well_____-__________Distance from foundation--------------------Distance to nearest lot line_________________ r . ' Number ine----------------- Number of lines------------------------------- Length of each line------------_----------__ ----Width of french Type of filter material------------------------Depth Depth of filter material------ -------------Total length------------------------------------------ S e Pit: Distance to nearest well------*-------------Distance� / -4m foundation--- ---------Distance to nearest lot fine__-___._ e a Number of pits-.------)-_-'--------Lining material--- 4-fff-Ar—Size: Diameter------33/ ------- Ce 4,001: Distance from nearest well----------------Distance from, founcla'fion----- -------- ---Lining material___________________. rWV ----------------- El Size: Diameter------------------ -------------------Depth--------- ------------------------------------Liquid Capacity-.............. . gals. ------------9 Privy- Distance from nearest well----- --------------------------------------------Distance from nearest building____._..________________------_-___-----. ❑ uilding----------------------------------------- El Distance to nearest lot fire Remodeling and/or repairing (describe):-----C--- ----------------- Z;-------/-a-,__--- - -- --------- ---------------------------------------- -------------- -------- -------------- ------------------------------------------------ --------------------------------------- ;;;e,�-------------- ---------- ----------------- ----------------------------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify hat I have pre ared this application and that the work will be done in accordance with San Joaquin Count i'y rfo y ordinances, State I 4, d rule egulations of the San Joaquin Local Health District. (Signed)---------------- -------------- - -------- ----------—----------- -------- (Owner and/or_!;onf for) By:------------------ ----------------------------------------------------- ---- -- - -- - ------------------------------(Title)------ ------------ (Plot plan, showing size of lot, location of system in re 0ion to wet , uildings, efc.. can be placed on reyers---si _ 2� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_------.'rPA-T-�---- -------------------------------------- DATE--------- ------------------------- REVIEWED BY----------------------------------------------------------------------- ------------------- ---------------------. DATE ------- --- --------- ------------- -- ------------- BUILDING PERMIT 155iJED------------------- ------I--------------------------------------------------------- DATE------------------------------ ------------------------------- Alterations and/or.recommendations:--,A-, ------------------------------------------------------------------------------------------------ -------------- --- lrkt ------------------- -- ------ ------------)p------- ----------------------------------------------------I------------------- .Z �TI�11�j .1----------- ... --------------------------m......... w. ------------- ----/-r----- ------ ------- -- --------------I-------------- :----------------------------- -------------------------------------------------------------- ----------- ----------------------- --------------------------------------------------- ---- -- - ----- - - ------------------------ ------------------- ------------------------------------------------------- FINAL INSPE& Date----- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revises a 1.577 F.P.CO.