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APPLICATION FC, SANITATION PERMIT.' Permi <br />\rni . ----------------------- <br />5e �\_11 A, /)I'- �, (Complete in Duplicate) Date Issued <br />Application <br />lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />T application is made in compliant ith County Ordinance No. 549. <br />JOB ADDRESS AN LOCATION -- ----- K ...... <br />Owner's Name- ------ -- ----- ----- Phone------------------------------------ <br />Address ..............•••---•--........ e--') ------ <br />Contractor's Name----------•--------------------------------------------------------------------------------- Phon,,�_Z_—f 6Q2 ----- <br />Installation will serve: Residence E] Apartment House Ej Commercial 1pTrailer Court 0 Motel 0 Other E] <br />Number of living units: _______• Number of bedrooms --------- Number of baths -------- Lot size.34/ <br />Water Supply: Public system E] Community system El Private �epfb to Wafer Table/ -'Y ff. <br />Character of soil to a..depfh of 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam E] Clay [] Adobe R<Hardpan El <br />Previous Application Made: Yes _E1 No ge" New Construction. Yes 9KNo Ej FHA/VA; Yes El No [:1 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br />---- Distance from foundation --- <br />w -A' <br />Septic Tank: Distance from nearest ----- �Aaterial__---- ------- <br />- ?,g <br />No. of compartments --a ---------------- - ------- Liquid depth---- ---------- pacify --- a <br />Disposal field: Distance from nearest well_/5'&'r____.Dis+ance from foundation ---- 6_0 . . ...... Distance to nearest ]of line________._._.. <br />1. - d h ------------------- <br />Number of iines --------- 1-Y-- Length of each line --------- 5-b ............. Wi f of french ------ <br />IF ------ em <br />Type of filter material- ---- Depth of filter material ------ Total length --------- 2 - -- --- __________________ <br />Seepage Pit: <br />Distance to nearest well________________ <br />-_-___ Distance from foundation -------------------- <br />Distance to nearest lot line-._____._________ <br />0 <br />Number of pits ----------------------Lining <br />material ----------------------.Size: Diameter ------------------------ <br />Depf h ---------- ---------------------- <br />Cesspool: <br />Distance from nearest well ----------------- <br />Distance from foundation -____..____-___---_Lining <br />Lining material-------------------- ----------------- <br />R <br />Size: Diameter ------------------------- <br />: ------------ Depth -------------------------------------------------- .--Liquid <br />Capacity ----------------------------gals. <br />Privy: Distance from nearest well -------------------- ------------------------------ Distance from nearest building_____.___--_--_----_------_-----.---.-. <br />❑ <br />uilcling----------------------------------------- <br />El Distance to nearest lot line--.---.----- <br />--------- ------------------------------------------------------------------------------------------------------------ <br />Remodeling and/or repairing (describe): --- * --- 0 ---------------- <br />---------- ------ ------ <br />- <br />------- -•---------••--------• <br />------- ------------------------ <br />----------- -------- <br />---- -- --------- - -- --- ---- ---------------------------------------- <br />---------------------------------------------------------------- ---- ------------------------------------------------ ---- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. <br />�,Iaw _ d <br />....... (Owner and/or Contractor) <br />�(ignedij - -- ---------- - --------------- --- --- ------------ <br />------ ---------------------------------- ------------------- <br />By: ------------------­-­-- ......... ...... ...... ------------------------------ (Title) --- Awl -------------------- __ ------------------------ <br />(Plot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). <br />FCA DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ---- --------------------------------------- DATE ------- ---------------------- <br />REVIEWEDBY-------------------- I ---------------------------------------------- ---------------------------------------------- DATE ----- -------------- <br />BUILDING PERMIT ISSUED_ --------------------------------------------------------------------------------------------------- DATE ------------------------------------------------------------- <br />Alterations and/or recommen4afigns:_ - - ------ _1 --------------- <br />Lk -ir - ----- ----------------- <br />------------- �r --------------------------- <br />------- --- ------ y ... ................. ........ <br />6� ------------------------------------------------------------------------------ - -------- <br />-------------------------------- Vol <br />W - ----------------------------------------------------------------- -------------------------- <br />.FINA12 INSPECTION ----------------------------------- Date ---- ----------- - ------ --- -------------- ----------------------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California California Manteca, California Tracy, California <br />ES -9-2M Reviseci 1-57 FRCO/ <br />