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APPLICATION FOR SANITATION PERMIT Permit No. _L____ _ _ _.__-_ (Complete in Duplicate) Y , Dafie Issued Appricafion is hereby,made:to the Sa oaquip Loc Ith District"'for a permit to-const ct and in tall the ork ein d ')ed. This applicatio in cor��lid h Caurif an e No. 549. � it JOB ADDRESS AND LO ATIO = ------ - - `-- - --------.... - y -- '------- t. � Owner's Name________ Address-------------t --------- l 1 t = -------------------------------------------------------------------------------------------------- --------------------- C«ontractor s Name----------------- -= -:"r = = =hone = f Installation will serve: Residence [°Apartment House ❑ Commercial ❑ Trailer Court #� Motel ❑ Other f �{ Number of living units: _ ---- Number of bedrooms___ Number of baths _ __ Lot size!_:_ ' ._, -- ---------- Water Supply: Public system ❑ Community system ❑ Private [5-15e�pth to Water Table 'f' 1 Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay A2ldbe ❑ Hardpan E] 4 i Previous Application Made: Yes F-1Yr-`NewNYr-`New Construction: Yes � ❑ 9' �o ❑ FHA/VA: Yes No 1 � . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weIl�l_- �+___Distance om foundation tion__-_1 :______Material___ 110 i No, of compartments----_/R,.a.________..__Size_4 � _ _4�j Liquid depth---1016 --::________Capacity"_ __ I Disposal Field: Distance from nearest well 11 '__.':...Distance from foundatio __ _--_-.Distance to nearest I line. -------------- Number _.__: Number of lines___..__. ___ Len th of each line_____ f----------- f- '_ Width of trench. - . Type of filter material_;- epth of filter. material___ __:_____-_Total length_____��_--_________________.____-- p,' �' % / c.,, Seepage Pit: Distance to nearest well----� 0._Distance from f dation___ _-____..D's e to nearest..of T T"1s-._� Number of pits----/--------------Lining materiaL��-Size: Diameter_a ,.- -----_-----Depth-_- - !:--_----- -----. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material ------------- 1771 _________- O ❑ Size: Diameter------------------------- -------- Depth------------ -------------------- ----------------Liquid Capacity-- -- .gals. Privy: Distance from nearest weft------------------------------ ----------------Distance from nearest bwilding_._________------.-__-_-_____-.__---..---. Y ❑ Distance to nearest Jot line----------------------------------------------- •--- . - .... -----------------f --------------- -------------=------- ---------------- ---------- Remodeling anrepairing (describe):-------- ------- ---- -- - .- :...-- .-..-.----- �� / -------------------- --I[----------------• ---.-----•--------•-------•------------------------------------------------------•----------------•----•-----•---------------------------------------- --------•----------------------•-------------- �� lM ------------------ 3 --------------------------------------------------------------------------------------------- '------------------------------------- -- N, ----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courity,� ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. s (Signed)------------------------- = = �!-��. --- ------ --- - ---- -------------------------------------------------------------- Contractor) I� B -------------------------------------------- -------- ' ------i - ------- Title f (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). i� FOR DEPARTMENT USE ONLY ,I APPLICATION ACCEPTED-BY---------------- - - DATE------------•----------_-- --------------- ----------------------------------------- REVIEWED BY---------------------•------------------- - --------------------------------- ------------ DATE-------'-------- BUILDING PERMIT ISSUED----------- - ----------------------_-------------------------------------- DATE------------e------------------------------------- ------------------------ - A`Ilteratiio/1ns�a�]n/(d/or recommend �ations: --------------- ----------- I , � a _ _ L_-7r. _ ___--------------------------------------------- ---- __moi - -6 � D� _._._!`------------1_0_____________. (& ------- x_61 ------.--z' .�� 1=!`--�'+-`!- �____�,.t4?.`r_.. "FA hiF 9, I�.y �J 2sGf� DY � t1 C s ,.,�, + S 01A1 FINAL INSPECTION BY: /d`rC/ Date � - ' q/! SAN JOAQUIN LOCAL HEALTH RI TRICT j130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' Stockton, California # Lodi, California . lAanfeca, California -Tracy, California .s f E5-4-2M Revise 1.57 F.P.CO. �