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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ---- Application hereby 'made---Is hereb -ma de to the San Joaquin\Local Health District for a permit to construct and install the work herein described. applicatiori is,made in compliance'with County Ordinance No. 549. iON-__ JOB ADDRESS A ",IT 96---G ---S-0deJ]----------------------------- ------------------------- ------------------ ---------- -------------------------------------------------------------- Phone------------------------------------ Owner's Name------- J---JCL-------- Address--------------------------- -±Z.--- ---- --- - ---------------------------------------------------------------------------------------- ----------------------- - Contractor's Name------- ---------------- ----------- Phone--------------------------- ------ Installation will serve: Residence,` Apartment House E] Commercial [] Trailer Court [] Motel E] Other El Number of living units: ---I--- Number of bedrooms . Number of baths ---F--_ Lot size -_-------------------__. Water Supply: Public sysfemA 'Community system El Private E] Depth to Wafer Table AY)ff. Ir r-h Character of soil to a depth of'31,64W Sa'nd'El 6ravel 11 Sandy Loam Ej Clay Loam Clay 0 Adobe, Hardpan I E] � F1 Previous Application Made: Yes E] No �New Construction: YesK No El FHANA: Yes El No x ij TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool pe4nitted if public se er is available within 200 feet.) Septic Tank: Distance from nearest we' 110i'P, _�istance from foundation----/6-------- No. of compartments-------------- -- Size---------------------------------Liquid depth--------------- ------Capacity----------------------- Disposal Field: Distance from nearest well- Y" from foundation? -Distance to nearest lot li7 Number of•dines'A, -- - ---------Length of each lirie-ze Width of trench---;?- Type of filter material Depth of filter material____ _Total length —In44V Se Pit: Distance to nearest well_j`7KA. isfan"ceromjfo ti n---49 C)-------DisVnce to nearest lot line____ Number of pits.--- ----Lining materia------------- --- - ------ Diameter-- 3-0- --------Depth---A-0--------------------- Vl Cesspool: Distance from nearest well-----------------Distance from ecundafion--------------------Lining material----- I -� ------- ------------------------ El Size: Diameter----- I-------------------------------Depth------------------------------------------------------Liquid Capacity---------------------------- els. I Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building------------------------------------ --- ❑ Distance uilding------------------------------------ --- Distance to rvmres jo 'ne------- -------------------------------------------------------------- ---- --- �,t , ----------------------------------------------------------- Remodeling and/or rep V��ingle�si e):----- - ------ . ............... (d ---- -----I----------------------------------------�_ --------- --------------------q-0--'=----- - --------- -- ------—-------------- --- --- ----- --------------------------------------- --------------------------------------------------------------------------------- -------------------------------------------------------------------- --------------- - ---------- -------------------- --------------------------------------------------------------------------------------------- ------------------------ ----------- ----------------•--=------- ----------------------------------------------------------------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 rulesArid,:regulaflons of the San Joaquin Local Health District. (Signed)------------- ------ ------------------ --------------7---------------------------- -------------------------------------(Owner and/or Contractor) By:. ------------;...... .1 ----------(Title)----------------------------------------------------------- *------------- -------------------------------------------------------------- (Plot plan, showing size of lot, locefionqof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---- ---- -------------------------------------------------- DATE REVIEWED BY---------------------------------------- ------ ------------------------- ----� DATE ----------- ---- ---- - ---------------- BUILDING PERMIT ISS.LIED--------------J----------------- --- -- - -------- ----- ----- - ------------------- DATE___7_ : on do s.-- Oons and/or recomm - Altera 110 5. ---CA -- —------ -------- ----------- V:V�M_ - -- ----- ---- - - ----- ------ --- --------------------------------- -------------- -------- ----------------------------------------------------------------------------------------------------------- ---9- --------- ------ ---- --- ------------ oft-—------------------------------- - - FINAL INSPECTION BY; Date 40_ ---- ------------ --------------------- --- ----------------- ---------------------------------------- SAN JOAQUINILOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore-Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revisea 1.57 F.P.CO-