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, ".. APPLICATION FOR SANITATION PERM?, ePermit No. .._ ..7:.. (Complete in Duplicate) ' �l / f J � Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to c nstrtrcf`and install the work herein described. This application is made in compliance with County Ordi nce No. 549 JOB ADDRESS AND C ION. ' « G�?.......................................................... JF J4 Owner's Name---------- e '� � 'Ar... ----- Phone............. ...... ...;..,.. ' gip► Address.................. _ --- Contractor's Name -----yI��G Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer.,Court ❑ Motell❑ Other ❑ Number of Jiving units:_ __ umber of bedrooms ,� Number of baths ___ Lot size .....e` -•. -.......- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4'r ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑' Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe ''Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No� HA/VA: Yes F-1 No 19-►-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well_ ! bistance from foundation..... ...........Material _ , ^t� No. of compartments -_____- ✓�r__. _ �___.__.Liquid dep. � - p .r2.. Size---•- •-- q P ��--------Capacity:.. --- - Disposal Field: Distance from nearest well-----" .Distance from foundation /` .Distance to nearest lot liner,v - Number of lines ---../ ,�ength of each line--- 7_ j .Width of trench .2 A,� . Type of filter,materiaL/ Depth of filter material:,_,l�''��------Total length.....,�.'r'�.............. (,, f Seepage Pit: Distance to nearest well ___..__Distance fro fou atiorf_...��... .Distance to nearest lot line Fr Number of pits 4_-----------Lining material, Size: Diameter. .----- Dep#h sk Cesspool: Distance from nearest well..............___Distance from foundation----------------_-Lining material.---------_........................... ❑ Size: Diameter------------ --- --,-------------Depth------------------------------------- - -----w..Liquid Capacity..............•-------.......gals, Privy: Distance from nearest well---------------------------------_------------ Distance from nearest building___---------- ---._- -.--_---.Distance to nearest lot line-__. ------ Remodeling and repairing (describe): �K�s { --------•••................ ........••-----------•-•-•--•--------•--- ---.---- _•-----. ------ ...............................• •--•-- ---------•------------ ------ ------•--...--------------------------------- ..... .__ •............................ .................•--•--...__..__.•----------" _-- ----• --. ....._... ------_- - -•---' -_..__._........................ _..._._. I hereby certify that I have prepared this application and that the work will be done in accordance with San-Joaquin County ordinances, State laws, an rules and regal 'ons of the San Joaquin L al Health District. / 9 ✓(`', (Signed) - - =�---- (+E�1war�iwsl"or Contractor) . -------- (Plot plan, showing size of lot, locati f sys#em in,relation to wells, buildings, etc., can be placed'on re4girse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- __ DATE ,t f REVIEWED BY --- - - _.---- DATE fr BUILDING PERMIT ISSUED -----•---•--------- --- •---- ----- ................................... DATE ......... ............... .• •---- ...-----•. Alterations and/or recommendations................. ------............ ......••- -----• •-•---. •--- =--..• •-•--- ----.... .... ........................................................... - - - • - - - - 7� -----•--- --•-- ---.----• -� p� t - r .. --•---- -------- -------•_ -------- -_........................................... .. .......... FINAL INSPECTION BY:.-_.D --- - - Date'---- ` � ........ --•---._ .------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132'Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.P.CO.