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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) pate Issued District for a permit to construc Application is hereby made to thet and install the work herein descr ibed. San Joaquin Local Health This application is made in compliance with County Ordinance No. 549• + JOB ADDRESS AND LOCATION- �- ----� G��------0 Y-49---, Phone .F{�2f c • ----------------------------------------- e Owner's Name------------ t --------------- 4 w ► ---------------------------------- Address-_ -------- Address------.. il'Y�.�---�----------------------------'---------- --------------- ----•----- �1 I' .� '; ---. Phone.-... Contractor's Name----- Pesi�dence 3- ''-----` ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑Installation will serve: 'Apartment House ❑ - -----LA--U------- Number of livirig units: -1- -'Number f bedrooms -----7-- Number of baths ---� Lot size Water Supply: ' Public`system ❑ Cornmun'i system ❑. Private ❑ Depth }o Water TablQft. _PP y .� �... Clay Loam Clay Adobe Hardpan ❑ Character of soil toga depth of 3 feet-4,rd Q Gravel ❑ ' Sandy Loam ❑ Y ❑ y ❑ Previous Application Made"' -Yes ❑ No" New Construction. Yes [j No E] FHA/VA: Yes ❑ No ❑ nlp �F e Prev pP Md TYPE OF INSTALLATION 3.AND SPECIFICATIONS: . (No septic tank or;cesspool permittedf f kk .public sewer is available within 244 feet.)., e t' �Ta�k: Distan ro nearest weil"�_. y-Distance from foundation uid de }h--Material---------------Caxacity----------------- S �*.--• . (�'*:.`No sof'compartments ± � Size E q p p � funciationT" ",---Distance to nearest lot line-___--__ ____-. s ' •r� IbDist'ance f°rom nearest Well_-------- ,Distance ofeach1i Width of trench ----------- ------ y Disposal field: a ne------------------- I 1 o " Type er of lines-----;- . - ---------:Length S i Numb -€--.-Total len th Y------ F `_De th of filter material" -_-- g yp of filter material ---- ---- p t j. ' p 9 _Distance to nearest: line p- I See a e Pit: �'D:istance to nearsstYwell` l0_ -----Distance from foundation --_ �' est: !----- ----- Linin rnateriai__�,V CJ_ --.-Size: Diameter__-- ___.Depth Number of pits:-.- ----------------- g t= V1 - --- Cesspool.: Distance from ,nearest well Distance from foundation--- -'''; Liquid Capacity-------_-------------------gals• ❑ Size: Diamete� ---------------- ----------- ---..Depth---------------- ------ x !t Distance from nearest building_---_---_-._--- ------------------------------ ------- 4 Privy: Distance from nearest well_`------------------- .F _--__-- - Distance'to•nearest to}line-__-------------"�""`'- -'- ' "- -' --------=--- --------------••---------•----•--•---_--------------------------- :. Remodeling and/or repairing (des rite}:-__a---------------- ----------------------------------- _______________ ---------------------------------------------------------------------------------------------------- ---_-_.___-_---__---___-.___-_.-.-_-_-.-------_---.--------- --------- ---------------------`-------`------------'--------__;-.------------------------ -.-_-_•--- _----- _.---__-___---______-_--_---_-.---_-__.---_-_-_.__-•---_-___--_.-'-- ! 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 rules and regulations of +he San Joaquin Local Health District. Contra �� ---- -or -1 1" [Signed} { ' ------------------------- ------------ s } s- ---=--- itle� ` = -- g P (Plot plan, showing size of tat, location of system in re ion to wells, bu ldin s, st can be laced on reverse side]. 9 � FOR DEPARTMENT USE ONLY rDATE t-P--------------------------------- . APPLICATION ACCEPTED BY__ = -------------------------- REVIEWED BY-------------`-•-•---:-------�T �----------- ----------- -------: - - = �'�'' --------------------------- 'DATE BUILDINGPERMIT ISSUED------- ;---------------------------------- ---- c�----------------------------------- ---------- Alter6+ions and/or recommend ations:-------------------------- -------------------------------------- =- ------- ----•--- ---------•- •-- --- -------------- ---- ------------------- x -------------------------------------- -------- - Date-------- ------------------------------------ --------------------------------- FINAL INSPECTION By:-0.4� � ----------------- ---------------- C SAN JOAQUIN LOCAL HEALTH DISTRICT l32 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy. California Stockton, California 1 Lodi, California Manteca, California y ES-7-2M Revised 1.57 F.P.CO.