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APPLICATION FOR SANITATION PERMIT Permit No. __tQ9........... (Complete in Duplicate) Date Issued �- - F Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal This application is made in compliance l the work herein described. w• h County Ordinance No. .549. JOB ADDRESS AND LOCATION__._ Owner's Name----------(gC ----------/-- ---t----------- --------------------------- `------------ Phone- Address----------- hone_Address________________ 1 -----------•-------------- - - ------------ ------------------------------------------------------------ ----- - ------- Contractor's Name p^ 1 ? _r a------------------ Phone_ a_2r7 ` ---------- -- --- - Installation will serve: Residence Z partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f_ Number of bedrooms __lf-Number of baths _�___ Lot size _ ' J T m. - -------��-- ----- Water Supply: Public system ommunity system [] Private ❑ Depth to Water Table _2417 Character of soil to a depth of 3 feet: Sand ❑ pravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: No se tank or'cesspool permitted if public sewer is available within 200 feet.) V !stance from nearest well---]'t!f_� -Distance fro��fou ion_/d_-_--____-Materi�___( C - c.� V No. of compartments--- t-.--j------------Size--- - ----r�- Liquid depth . `'----__--- --Capacity-- ----- --- r an Dis osal Field: p _ Distance from nearest well.��-_.Distance from-foundation__�Q-_____Distance to nearest lot line---- Number of Number of lines___'___l__ - _.____ Length of each line__�__Q-*_- Xi- ,f Width, of french___- �—--- 6 Type of filter material______ _ __Depth of filter material_ _ Total length........Z-42__f --__------------- 1 Seepage P : Distance to nearest well__k/_�-------Disfance om foundation ___/__d-�--,D•stance to nearest lot line---- _-_ �Jl� Number of pits________--_-------Lining material______ =._______Size: Diameter_, �1-.----Depth__��*________________ Cesspool: Distance from nearest well----------------- fr foundation_____.._______.__-Lining maferial__________________________.________. V) Cesspool: Diameter -----------.Depfh----------------------------------------------------Liquid Capacity------------------------- gals. Privy: Distance from nearest well--------- ❑ Distance to nearest lot line---------_-._--____________________________________Distance from nearest building----------------------------------.------ ---- _---------------------------- >. Remodeling and/of re -- - --_ - -A,jox. � ----iring (descrih -- � r- -------------------------------- ---------------- - ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- hereby State -ws a y I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, and rules and regulations of the San Joaquin Local Health District. � (Signed) -- -- �__Is-444 _f 7 �{ Contractor) Plot plan, showing ---- --------- Tiffe)---------------------------------------- ----- + ( p g f lot, location of system in relation wells, buildings, ., can be placed on reverse side). ( FOR RTMENT USE ONLY APPLICATION ACCEPTED BY- ----- - - -------------- ----------------------- DATE- ---------------- ED BY - -------------------- ----- ----- DATE --------------------•------------------------------------ BUILDING # PERMIT ISSLIED------•--------------------•----------------------------------------------------------------- ------ DATE---- - t a+ion d/or r commendati -- ---------------------- -------------- ----------•--------•------------ ----------------------------------------- ----------------------------------------- -- r -- ----- -- --- -- i--- ---------,�.---------------------- �-. FINAL INSPECTION B Y:.- Date S" - -- --- - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 West 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-