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APPLICATION FOR SANITATION PE MITA Permit No. JDS_I_I___ l,� �� ' (Complete in Duplicate) ' � �b Date Issued 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 Ordinance No. 549. 3ti( -0 r? IW JOB ADDRESS AND LOCATION... ---l---- Owner's Name_C04,I.1 Er----- aAMAI---- .0.'----------------------------------------- Phone---------------------_------------- Address______ _ Contractor's Name__ --- 7 -_ _I _ / ��, Phone Installation will serve es{dence ❑ Apartment House E] Commercial E' Trailer Court ❑ Motel El Other ❑ Number of living units: __-_ Number of bedrooms -"""__ Number of baths -1------ Lot size ___� _- Tz-_15-- Water Supply: Publics stem Community system Private -- PP Y� __ y ❑ y y ❑ �' Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay_ Loam ❑ Clay ❑ Adobe (/ Hardpan ❑ _ Previous Application Made: Yes ❑ No Er New Construction: Yes ®' No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) FAQ �Q C�_TF 1 Septic�Tank: Distance from nearest well__/��_ ___Distance from foundation_,!! ".Material___ ------ _C"-_-'R'RIcr, _--_- No. of compartments---------f''"'---------Size--------------------------------Liquid depth-------------- -----------Capacity---- QQ- . I Disposal Field: Distance from nearest well_13a.......Distance from foundation----5C.a__..__,-Distance to nearest lot line__19-_------ I Number of lines_____________ -----------------Length of each line- -Pa R "� ._.Width of french------_r'�__ Type of filter material-__._9_0<- (.____-Depth of filter material------�_� -------Total length--------1.1 ------------------------- Seepage __________________ ___ Seepage Pit: Distance to nearest well__ 20_ ng material__-_�l��K_-.--Size: Diameter---_.,��..........--------Distance from foundation___., "___..Distange to nearest lot line_ pits---? Lini _ f Number of Deptn-------25" -- ------------------- Cesspool: Distance from nearest well---Ni2NT-_Distance from foundation-------------_-------Lining material___----_______________________.-_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------- - gals. Privy: Distance from nearest wO-------------------------------------------------Distance from nearest building------------------------------------------ I ❑ Distance to nearest lot line---------------------------------------------------------------••------------------•-------------------------------------------------------- Remodeling and/or repairing (describe)----------2------- QN------ -------40-s/-�----�6--y-�---VI//' '� --' - -------------------------------------.--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------•-•---------------------•--------------•--•---•----•--------------------------------------------------------------•------------------------------------•---------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------------------------------ - --------- -----------------------------------------------------------------------------(Owner and/or Contractor) By:------------------••------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4 � . t APPLICATION ACCEPTED BY---- '� ---------------------------------------------------------------- DATE �� REVIEWEDBY------------------------------------- ------ ------------------- ------ ---- ------------ ------------------------- DATE---•----- - ��i BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:--------------------------___ --- - -- --- ysr1'Sla -----------•--------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------------ -------------------------------------------------------------------------------------------------------•-----------•--- ----•-----------------------------I----------•-• ----------- -- ---- - ------•--------------••-------------------------------------- --- ------ -------------------------------------------------------------------------- FINAL INSPECTION Y:. ----- -- Date--------------L --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F.P.CO- e