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• APPLICATION FOR SANITATION PERMIT Permit No. ___/Z-6_:?�_�._ (Complete in Duplicate) ll Date Issued __�/-_/�_Q:___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described t 4. This applic fion- is made in compliance with County Ordinance No. 549. - ' rA f JOB ADDRESS AND Owner's Name - �- -- T - --- = P one-1 ` 'd Address 1 - ..... Contractor's Name--------------------•--•-----_-- � - --- - - ----•----------- ----------- - ------- ---•-- -------- -------------------------------------- Phone----•------•-----•----------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ] Other ❑ Number of living units: -1---- Number of bedrooms J-7—Number of baths __ Lot size ------ Water __-Water Supply: Public system ❑ Community system ❑ Private Er-bepfh to Water Table I-._ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes [-❑ No U New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspooi permitfed--if-rublic sewer is available within-200 fee#:)� _ Septic Tank: Distance from nearest well__ Q- "'Distance from fo nd le 1 Y n� _- '1 'Mat real -. ------ No, of compartments......�_-__- _-:Size_f_,_5_ __•_Liquid depth----__'��`------------------ Capacity d � p y--- ----- Disposal Field: Distance from nearest well stance from foundation-A0.7v.-W-*" Distance to nearest lot Number of lines---------�----- - -_--�- Length of each line--------�_Zo------fj-__.Width of french-----�-�-��--- Type of filter material.....3- - ---------Depth of filter material----.`_ Total length-------- ----- ----- Seepage Pit: Distance to nearest well---------__----------Distance from foundation--------:_'.---------Distance to nearest lot line_---_-.-----_-.- i ❑ Number of pits. --------------- Lining material Size: Diameter_ --------.Depth------------------ Cesspool: Distance from nearest well-----------------Distance from foundation----------------....Lining material------------_--_----------------------_--_---._-- f ❑ Size: Diameter-------------- --------------------Depth--------------------- ----- -------Liquid Capacity ------------------ - ------gals Privy: Distance from nearest`well--------------___-. --_ _-_ --:_-Distance from nearest buildin g ❑ Distance to nearest lot line_____________- -____- Remodeling and/or repairing (describe):............................ _----------------------------- ------------------- --------------- = --------•-----•-----------------------------------------------•----•---------------- ----------------- ---------------- --------------------- cyv `---------------------------------••------------------------------------------------------------- ----------- '1r�° I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count 'l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---.-___--- • ---- -7 --�------------ -�--------- ------------- ------ ------ ----------- ------------ ------------- ----------- ------(Owner and/or Co ntrecfor) $y ._ _• (Title)--------------------------------- - - --- -- - - - - (Plo+ plan, sho rnze y `f I +, location of system in:ela#ion'to welIs,buildings, etc., can be placed-on re`vei;a side). FO SPAR SE ONLY APPLICATION ACCEPTED BY ` ATE--- BUILDING PERMIT IS SUEE D______ / REVIEWED -- - --------- ---------------------------------------- ----------------------------- --- DATE------------ ------ S ----_--- - --------- �-------------- ---------------------------------- --------- DATE--------- Alterations and/or recommendations:--=----- -------- ------ --------------- -------•--�----•t-`------------------------- I! f € --•- ------------------------------------ ---------------------------- -••------------------------------ •--------- -----•------------------------------•-- -------------------------------------------------------------- = -------------------------------------------- .�r� -•' /-r-- ) - , -- •-- . -A I - l FINAL INSPECTION BY:---------------- ------------------------------------------ Date.------------------------------- - 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 Revises 1-57 F.P.CO.