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1 11 �S APPLICATION FOR SANITATION PERMIT Permit No. ___ - 1..... (Complete in Duplicate) Date issued _7------ =� Application is hereby made to the San Joaquin Local Health Disft ict for a permit to construct and install the work herein described. This application is made in compliance'with County Ordinance .No. 549. JOB ADDRESS AND LOCATION---'Y -- `S��?-----r- ------- ------------------------ Owner's Name--------- ' (d S_, . L/_� .-.: I/ l�� r---------------------- ---------- Phone , 7 Address_.... 71� fes' ��1i/ -5' ------------ s Contractor's Name--- =------'+�. c '6 on zd C Ph Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 7----Number of bedrooms _Z_ Number of baths _ - Lot size ------ Q.____ _____/41--------------- r` I (!a ft. Water Supply: "Public systemr Table ^ Community system❑ Priva+e ❑` Depth to Wate Character of soil.i�o a depth of 3 feet: . Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan [I Previous Application Made: Yes ❑ No X New Construction: Yes El No FFiA/VA: Yes ❑ No 0,— TYPE OF INSTALLATION AND SPECIFICATIONS: - n + ' o septic tank or`cesspool permitted if. Public sewer is available within 200 feet.) is Tank: Distance from nearest well_________________Distance from foundation_.-----------------Material ----------------------------------- No. of compartments-----------------------`-Size 1-----------------------------Liquid depth--------------------------Capacity----------------------- I Field: Distance from,nearest well-----_--"_---___-Distance,from foundation-__.____.___I------D]stance to nearest lot line_________________ ❑ Number,of lines-----s---------`I--------------- Length�of each line------------------------------Width of french----------------------------------- Type .----.--------.--------- _.---- Te of filter material-_4_;________________Depth of filter material-----------------------Total length-------------------------------------.__.. age it: Distance to nearest well_>- Q, F�-'_Distance fr,�m founaation--- d Dista�e #o nearest lot.ling______ Fa ` ' ❑ � Number of pits___'"'�_________�Lining material__.___ , C?�°�.Size: Diameter__,,�3. __...___.Depth____,..Z.S --------_______ Ce ool: Distance -from nearest well____ _ Distance from foundation_____________ ___'.Lining material------,------------------------ ----- i ❑ Size: Diameter------ --------------------t ----Depth------------------------------ Liquid Capacity gals. Privy: Distance from nea festwell- ---- _ ��_ --------------------------Distance from nearest building----------------------------------------- Distance to nearest lot'line--- .sz� Ak ----------- --------------------------------------------------------- I L 'Remociel� an /or repairing clscribe :_" -- --- -- -- - - --------- ---- _ •----------- ---- �- - � f = f1 5 --------- ---------------------------------------------------------- f s i ----- ---------------------------------------------------------------------------------------- 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; and as an.d regulations of the San Joaquin Local Health District. { 0 Si ned { 9 }--------•- ----------- ---- -�:---- - •-��------ --- ----- -- --Yiis �---� -�-��.5_ rrao�.and/or Contrac#arl BY- = -----------•-•(Title]x1-(Plot plan, showing.size of lot, locatio of system in.relation to we , bui s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------- ------------------------------------------------------------ DATE-----------f-------- � -- DATE REVIEWED BY---------------------------------------- At ; ------------•------- BUILDINGPERMIT ISSUED--------- ------ ------------------------------------------------------------.-_ ------------------------------------------------------------- Alterations and/or recommendations:_ --------- _____ t. ------ --- ------------ ---------- ---------------------------- --q- ----- _ P ---------------------------•-- ---------------------------------------------- --- ---- � f - L' ---- -• ---------------------- - --------------- --A- --------------------- --------- --- FINAINSPECTION BY:-----f, `- ---------- ---------------------------- Date---------=--_-------=--------------------------------------------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 13Z Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California LS--9-2M Revised 1-57 F.P.CO.