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. APPLICATION FOR SANITATION PERMIT Permit No. _-_!�_ _(-3 I [Complete in Duplicate] ---- Application is hereby made to the San Joaquin Local Health District for a permit to construe} and ins}a Date Issued This application.,is,.maderin compliance with County Ordinance No. 549. tf,i" 8M i ll the work herein described. JOB ADDRESS AND t_OCATION _ � ---------- ^'Zl,� r Owners Name----- -------- �. - ��Address-.--- K"---------- ---- Phone. ------- - �•`�--f-dam_---------- r..,,.....ia _"_"_-___.."___".""-"__""""----------------------•------- _--""_" "." -------- ---------------Contractor's Name-___"-"-. !,� �-- ' Installation will serve: Residence �,,.+s ---- --------- ----- Phone---- --------------- t S tparfinenf House ❑ Commercial r Number of living units: _. _ Number of bedrooms -_ ❑ Trailer Co'ur't Mot l ❑ Other ❑ Number of baths -_ Lot size le Water Supply: Publics stem Y ❑ Co mmurs�}y system Private Character of soil to a depth of 3 feet: Sand ❑ Grave ❑ Depth to Water Table .ft, l ❑ Sand Loam E Previous Application Made: Yes ❑ No Y ❑ -Clay Loam,�'Cl,ay ❑ Adobe ❑ Hardpan [] [��New Construction: Yes [rtdo ❑ FHA/VA: Yes �'I;lo ❑ --TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------------- -------------- �_-Distance from foundation i / Material- No.No. of compartments -______ ""_-."_Size" s �, - 1 4� ;-X-Wl-------Liquid depth ------------ Qisposal Field: Distance from nearest """_ p j&--------.---Capacity----Ie _a------ + Distance from foundati n---� ' Number of lines_-_--_ -------------- _ e T----------Distan a to nearest lot line -e ------------------Length of each line--- __ Type of filter material / ��-.Widt'n of trench-- .--"----------11 {��+ Depth of filter material"-"� if Seepage Pit: Distance }o nearest well-"-_�^�" -------Total�„length-____��S ------- P01, "_ _ -- -f __Distance from foundation_.__f __ _ Distance to neares ot�rne-_/ (�� Number of pits._-"�__- ._ �----� Lining material-"- DG ..Size: Diameter_ . Cesspool: t -i------Depth "e----,---1 ❑p Distance from nearest well _Distance from foundafion.--.--_.----__----lining material---_ -.= Size: Diameter------- ---------_Depth -----•---------------Liquid.Capacit ��A Privy: Distance from nearest well ---- ---------- �-- - x _ ---"-- ":"_Distance from nearesf building Distance to nearest lot line" g- ------------------------------- '��jj ,�,� - ------------- --------------------ell /or repairing (describe---------- ---/�^�iK.e"- - Remodeling and --------------- -------------- -------------------- -------------------------------------- ------------------------------- -------- = ---------------------------------------------------------------------------------------------------------------- -----------------------------------•----••-------------------•--------------------------------------------------------------------------------- ion and herebycertifythat I have ordinances, State las, and rules and''regulations of the San J Joaqthat uin Local Hee work ralltheDitrictdone Fn accordance with San Joaquin County [Si ned g }--•------------- ----- -- ---- ---- --- ------ By:------------------------•-------------•=---- (Title) ontractorJ (Plot plan, showing size of lot, location of sy �ination to wells,buildings;etc., canbe placed on raver ). E 1 F r EPA�RTMENT Lg ONLYOf r APPLICATION ACCEPTED BY------ --- ---- ----------- ------ ------ ------ ----- . DATE � ,, REVIEWED BY------------- -------------- ------------- ----- DATE BUILDING PERMIT ISSUED-----------! ' ---------------------------- ------------ ---------------------- -------- DATE- �'""_--- ----------------------------------- Alterations ------------------- and/or recommendations:--____- ------------------------------------- -- --------------------------- FINAL INSPECTION BY:___-____.- ""-- ---- ------- -- -7----------------------------- -- Date-------- + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California _ "Lodi, California _ -Manteca California m. - Tracy, California " ES-9-2M , Revises 5-57 F.P.CO. r