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APPLICATION FOR SANITATION PERMIT Permit No. (Comp[ ate=in Duplicate) Application is hereby -- • _ Date Issued mads to pli San Joaquin Local Health District for permit to construct andAstall the work herein described. This application is made in compliancew h County Ordinance No. 49. JOB ADDRESS AND LOCATION/4Z"_ - k6 Owner's Namefil - .�' t • --------------- -- - - PhoneAddress •------ --------------- -------- ; Contractor's Name---------- --- - -------- - -- __ __ - �. --------------------------- - - ---- - -.. Installation will serve: Residence ' r ..------. Phone Apartmenf,House ------------- Number of fivin units: _- _- E r . ❑ Commercial ❑ Trailer. Court E] Motel 9 -_ Number of bedrooms ❑ Other �- Number of baths " ❑ Water Supply: Publics stem' _ Lot size -- (- , Y ❑ Community system ---------- ------------ Character Private a -•-------------- Character of soil to a depth of 3 feet: Sand ��pth to Water Table �ft. ❑ Gravel E] Sandy Loam E] ClayLoam Previous Application Made: Yes ❑ No —Clay E] Adobe �" New Construction: Yes ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPEC IFICATIONS: ° ❑ FHA/VA: Yes [�.�-ps(o {No septic fank or'cesspool permitted if-public sewer is available within 200 foe}.) ` Septic Tank: Distance from neaeesi well__ - - .� �- �� No. of compartments .4 ----Distance from foundation.-- --- _-- Mater al--- r p ► Size__._ j _ �.-.-Liquid depth_..___ r Disposal Field: Distance from nearest wefi_. - - Capacit Y_.*,_�v �' Number of lines--_-_-- --.Distance from foundation---��"-_ Length of,each line-__--_7 `__r Widfihcofttrenchast lot line_-. _ `_ ------_.-_"-- - f Type of filter material-- "---�" -- p ----# �� -De Depth of filter material-_/�--_--__ ---Total len t ,- �j u s g --/c Seepaga Pit: Distance to'nearest well__--.--/��' _ -_Distance from oun tion___ -___.Di ante to nearest lot line.-- d- R' Number of.pits------ - -------_-----Lining material_' 'A Cesspool: �' �- Cess ool: , ae:>Diamefer-- ------- -----------Depth-- __A0.A p Distance from nearest well------- .`--__Distance from foundation---__--_- - ---_'Lining material----------------------- ❑ Size: Diameter Depth_-_ Priv ., "`----Liquid Capacity gals. Y: Distance from nearest well _- 4 ---------�_- Distance from nearesf buildin � ❑ Distance to 'nearest-lot line.4._�_�_ . �._ ," - - ------- --------- - ---------------------- - _--- :: Remodeling and/or repairing (describe):----_ f��,f _ / .. ------------------------- --------------•--- -_-__._----_-_ —wry--a.�Mws,a ..--- •-_-""-__----_ •-•--_----•-_-_••-------------•-_••---- -----------------`------ "----- •_-• I hereby certify that I have prepared fhis-applicafion and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o the San Joaquin Local Health Disfricf. (Signed)-------------- sY: a (Title) r Contractor) (Plot plan, showing size of lot, at'on of system in..relation to wells, buildings, etc., can be placed on rev a side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_------_--------R ---------------------------------------------------------- REVIEWED BY = DATE ------------- ------------------ --- ----- --------- --- ------------- DATE------ k ---------------------------------------- ILDING PERMIT ISSUED-------- ' r-C---------------•--------------------"--- ---------- ---------- -- DATE --------------------------------- Alterations and/or recommendations-------------------------------------------------------- 1 ------------------- -- y -------------------------------------------- ---! ---s --- t r-� = c t.r?� 4Au 4-0-----lV---r-r----��t7�_�,U---i/ - ------ --'fr ----- -- - ---- _ sda-r... _efQe' --•--------•---- --• ----- •----- --------- -=- FINAL INSPECTION BY:--- = -�! ---------------- -=--" Date �_ fZ-S� ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT, 130 South American Street *4 .N,� A t �- r ", r. ..6 I 300 West Oak Street 132 Sycamore Sf4et s 914 North "C" Street Stockton, California Lodi, California Manteca, California r Tracy, California ES-9-2M . Revises 1-57 F.P.CO, ' ' ► -