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APPLICATION FOR SANITATION PERMIT Permit No. ....... (Complete in Duplicate) .-Date Issued ��f.._.,!IS g Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County-Orli ante No. 549. . -�1 f JOB ADDRESS AND,LOGATION_��J.d-� -e�`�`'`"� �----�---------------'� ---------•--------------------- 1 �., � (-_�lr�'� xr �.. ' '-------- -- -- ------ --- ----- Phone------------- Owner s Name__-�Cl -�l"__-----t--•----------------------fix.-------=---------- --------- /. --------------------------- Address.....----------- / - - ------------------------------------------------- ------------------------------- .._. / 7� i Contractor`s Name `r._.: ' '� ' :---------r--------------------- Phone.;r 7.7_ __. �� a t ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [T� Number of living units: -------- Number of bedrooms , Number of baths -------- Lot sizeC---�_4�_ ------------------•--- 1. Water Supply: Public system E] Community system [I Private ®Depth to Water Table ft + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: Yes ❑ No g�fNew Construction: Yes Uj-"No ❑ FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: Septic (Noseptictank or`cesspool permitted if public sewer is available within 200 feet.}! p �_ Distance from nearest well-53 from foundation_¢-_ .__.__.MateriaL� 1�� _________________`"r—/ No. of compartments-----X----------------Size- --- —'•- -.---Liquid depth--4--------------------Capacity.,OZ-0 a_.� . - S_'IV Disposal field: Distance from nearest t well-5.7.x.!__ .Distance from foundation_.�,�_--_____-Distance to nearest lot line_-S___J Number/of lines-----------�_-.------------------Length of each of trench__.__�2$/__----�_______________ - ,_� t ---De ' Type of filter materia(--� pth of filter material--__,� _.__._____-_Total length________._cr��__________ ________ Seepage Pit---- Distance to nearest wel{./��------------Distance/ff foundation----L_d--------.Distanceto nearest lot line----------------- Number _r__'S_ _ Number of pits.-__l`------------Lining material_-L/. ---.Size: Diameter------ ----.--Depth--,--- -tib------------------ i Cesspool: Distance from nearest well-----------' __Distance from foundation____________________Lining material------___-_________-______-____.___. a ❑ Size: Diameter------ ----------------- -- x-Depth-----------I--------=----- Liquid Capacity-------:------ ----•-gals. e (____._._Distance from nearest building Privy: � Distance from nearest well.-------------------- ----- -------� g------------------------•---------------- . ❑ Distance to nearest lot line_____________________ ir .. t --- 1 ' Remodeling and/or repairing (describe)--------- -------------' i----------------•-=-- ----------------------••------------------------- i. -,_w ; ----------- - ----•------------ I hereby cerf4 that I have-prepared this.application and that the work will be done in accordance with San Joaquin County ordinances, Staf .Idws, and rules and regulations of the San Joaquin Local Health District. _ F (Signed)--------- ` `� `� �3' ��-- _� -, -- ----------- -------------- ----•-----(Owner and/or Contractor) sY= � —' _" =�j. --------------{Title)------ ------------------------------------- (Plot plan, showing size of lot, location'of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - - ----------- DATE---------- :::,/ .S REVIEWED BY------- •-------------------------------------------------------------- -------------------------------------- -------------- DATE------------------------------------------------........ , BUILDINGPERMIT ISSUED--------------------------------------------- ------ DATE.------------------------------------------------- --------- Alterationsand/or recommendations:-------------- ------------------------------------------------------------•--------------••------------------..-_--_- ......____------- -------- ,--------------------------------•----------------------- --------- ✓r------------------------------------------•---•--------------------•,-•--.-----•--------------------- -----------------------------p2T-----p�-�'�--- ------915------ XJ8----- ----------49-X �'-Yt_°--'------------------------------------------------------------------------ -----•------------------ E S N------'W&KC.,------------1 ---- ---------------------------- ---------------------------- ---------------------- -----------------------..iE Tl a------T (AL1 S -------------------------------- •--------------------------•-----------------------------•-------- - FINAL INSPECTION :_.BYDate- SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9--2M . Revisep 1.57 FT CO.