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APPLICATION FOR SANITATION PERMIT Permit No. .___�_ _ _ � (Complete in Duplicate) k Date Issued Application is hereby made to tha SanlJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance-with County Ordinance No. 549. 1 ' L s I. t : JOBADDRESS AND LOCATION--- ------ ,---------? -----'-------------------•-----...---------r---- ------------•-•- '---------------------------• � � _S_ ` Owner's Name---- -� Phane lA Address.-•---------•------------�lti -L#ft VS A ------------ - k Contractor's Name----- In_-�`.L --I----------------------- ------ Phone.------ ••------ Installation will serve: Residence 14 Apartment House ❑ Commercial ❑, 'TrailerrCourt El Motel ❑ Other ❑ Number of bedrooms __ ____ N # Number of living units: t � � t: r g ____- umber of baths ---�-= Lot size ----�.(�-- �-------------------------•---------'---- Wafer Supply: Public system ' Cornmunif-" s"stem" Private ❑ `Depth"to`1Nati=Fr Tableft:"`'""i`" Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg} Hardpan [] Previous Application Made: Yes ❑ No R New Construction';' Yes '5� No ❑ FHA/VA: Yes ❑ No R TYPE OF INSTALLATION AND SPECIFICATIONS: :4 Tank: Distance from Dearest well--YLGYh _--Distanceailable within 20Q fee No septic tank or'cess ool ermined if public sewer is available H r :from foundation---=IC' ._.___. Material---=! -[vC - ---------------------- No. ----------- Septic - No. of compartments_-.- __Z--------------Size-S_`__? - --_ I ........Liquid depth-----4----------- --.CaPacity Q.`�_ Length olI � 1 r � Number of°lines__-__'�-••_�_____________ ____' 'Ifrom foundation-__:z-C---.-_-.--Distance to nearest lot line_----5---_-.-- Disposal Field: Distance from nearest wail__- P _C_�- -.Distgance''f each line �� Width of trench--- ci 1 Type of filter material---Yee-kt-------Depth of;`filter material--.-I-V----------Total length------..g.0---------------------------- Seepage Pit: Distance to'nearest well..........------_-+--Distancejfrom foundation_--.:.::--.---------Distance to nearest lot line__-_-----_-..- ❑ Number of pits._..--i--------------Lining rnaterial ;� --------Size-; Diameter------------------------Depth-- -- - ----- i P Size: diameters-- ------------------' , ----------.De th---=l: i'..- �-----•-------Lining material- ---------------------------------- El --- -------' " ` ❑ p from-----t fiion----- ------------Liquid Capacity----------------------------gals. Cesspool: Distance from nearest well--.--__-----.._ Distance Privy: Distance from nearest well---------------------------------------------- m--.--------__._ __Distance fronearest bui#d ------------------------------------------ ing ❑ Distance to nearest lot line----------- --- ---------" ------------------'� ._== T ---------•--------------------------------------•---------------------- Remodeling and/or repairing (describel: / -• ---------------------------------------------------- -----------•----------------------------------------F-------------------------•- --._"---------------------------------------------------:----------------'-----------------------------------.------....------------------'- F ----- `r -----------------------•----------------------------•---•---------------------------------------------- ------••----------- --------------------------------------------- - ----------------- - - ------------------------------------•---------------------------------------- I hereby certify that I have prepared this-application and th at the work will,be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ; I , ' (Sign ' ' 'L'3 - ± ----------------- By: (Owner and/or Contractor) I 9 ) = - --------------- B ----------------------------------------. .....--. --- - i {Title) •---------•--•----------------------------=---------- Plot plan, showing size of lot, to ells, buildings, etc., can be laced on reverse side i Y ( p g. cation of system in.relation to .g , r placed }• I„ # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'------- ----------------------- r-------------------------•----------- DATE----- �_' ti-------------- EVIEWED BY f' i--- -------------------------------- ---------------- DATE R -- BUILDING PERMIT ISSUED---- DATE Alter tions and or rec mmenda 'ons: ......3-- ,�pp ----- ------ -- ----------- - - _�`- — -----^-- --------- -� L ------`� =---------------------------•-----------------------------------------------------•--- ?.I FINAL INSPECTION BY: "'.��-,...� = r Date-__-�== = i =... � yv 71JGhL, I SAN JOAQUIN LOCAL HEALTH DISTRICT 1 Cys ! l i !130 5buth American Street I 300 West Oak Street' � 132 Sycamore'Street 8i4 North "C" Street Stockton, California Lodi, California 4 Manteca, California Tracy, California 1. I ES-9-2M Reviseti 1.57 F-P.CO.