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REq t>Y z--xa- f 3 R fir- APPLICATION FOR SANITATION PERMIT Permit No. ...1! TZ, (Complete in Duplicate] /Date Issued / This Permit Expires 1 Year From Date Issued ________/_d..__ 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. r�� JOB ADDR SAND LOCATION-----P. —r E .t ---------•------------ me VjT,0L --- _C1J_T------- •�-a13A------------•------------------------------------------------------------------------ ------ Phone��_�__��a------- "f* Address----a&------ ------Of j G •------- •-•---------- -----••----------------------------------------------------- ---------•-•--...._.- Contractor'sli Name;'_---Q_"_!/Vjff1a--------1_AJ_,5.!"_4L.L_e_p------------------------------------------------------------------------ Phone-----------:------•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numler of living units: ---!---- Number of bedrooms ___)____ Number of baths ___j__ Lot size _ ___,F)Ir2E_5_________________________"__ + [ � I Water Supply: Public system ElCommunity system ElPrivate; Depth to Water Table __71 ft. Character of soil fora depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No-R New Construction: Yes-;4, No ❑ FHA/VA: Yes ❑ Nol& TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__,' No. well__ r-- __.Distance from found:ation--- i_ .........Material_____________________.______ of compartments--------2--------- ---Size--- ---Liquid depth__---4-�--------------Capacify___�Q,O__� -tel Disposal Field: iDistance from nearest well..6---�--_._Distance from foundation---1__0_t-------Distance to nearest lot, Number of lines_____________ Length of each line_________ �O---------------Width of french--_'14.... ............ Type of filter material----R__O_� ------Depth of filter material----.--I1-----------Total length-------q,0________________________-_. Seepage Pit Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______._________ ❑ ( Number of pits;---------------------Lining material-----------------------Size: Diameter------------------------Depth----------------- =---------- Cesspool: Distance from nearest weil-----------------Distance from foundation--------------------Lining material_.._____________________.____________ . El Size: Diameter--------------------------------------Depth------------------ --------------------------------Liquid Capacity----------------------------gals. Privy: t Distance fr1 m nearest well____-------------------------------_-------------Distance from nearest building------------------------------------------ ❑ ) Distance to nearest lot line--------------------------------------------------------------------•------------------------------------------------•-----------r---------- ----------------- Remodeling and/or, repairing"-�descrlbe]:_-?'"" " M " ',•/ ----•"---------- _--------------------------------------------- -------------------- Its _" ---------------------------- ------------ ------------------- --- --- ----------------------------------------------- '-----------------------------------------------------------------------------------------------------------------7---------- I here bli certilly that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, IState laws, and t les and regulations of the,Sian Joaquin Local Health District. 3;U L` - Owner and/or Contractor (Signed} _ ------------------------- --- -I ) I ,- B t_ - -- = -- - ------------------ (Title) -------------- ----------------------------------------------- (Plot -------------------- ----- --------------- • (Plot plan, showingsize.of lot;=location.of-system-,in relation to wells,'EUdin;gss.,.etc., can be placed on reverse side). ll % FOR DEPARTMENT USE dr4Ly _� J APPLICATION ACCEPTED BY-------�_%------ - --------- --------------------------------------------------- ------- DATE---- - --•------------------- . BY------1----------------- - ---- -'`- ----- -------------- REVIEWED ----------------------------------------------- DATE---------------------------------------------------- = l BUILDENG PERMIT ISSUED ------------------------------------------------------------------------- DATE _ 4k1fer tions and/orirecommendatiqn's__________ ------------ ___- __ ------------------------------ ---------- --------------------¢-------- ------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:"---5 '---- --------..._ Date------ r�4- i---------------------------------- f 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 Revised B-'59 F.P.Co. r