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M n• ''r APPLICATION FOR SANITATION PERMIT Permit No. I� 5--- -••-- ! )li D i l (Compete n Duplicate). � a Date Issued- __-J.?_.--_---.-------.- Application is hereby made to the San Joaquin 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. A - JOB ADDRESS AND LOCATION----------- 1 i ---(---(4c----------------------------R- ----------------------------•--. Owners Name--------- �✓L'y-._ '�, — � �e ------------------------------------------------------------------------------ Address -- - ---- t r Contractor's Name------------ -----410 '; _111�fr4 v^►--`�L •------------------- ------------ Phone------------ ---------------------- Installation will serve: Residence F;1 Apartment House❑ Commercial [] Trailer- Court ❑ Motel ❑ Other ❑ Number of living units: f----- Number of bedrooms _9___ Number of baths _J---- Lot size --------------------------------- Water -------------------------- --Water Supply: Public system ❑Community system ❑ Private ❑ Depth to Water Table ft. . � li Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ©'ardpan E] Previous Application Made: Yes ❑ No D--"New Construction: Yes ❑"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance tDistance fromrfna ` 10 Material--- __-------___-. Capacity ` 0 -------- No. of compartments ___ .----Size-.- Liquid depth--------- r Disposal Field: Distance from nearest we1L.7?r`�-,'-_Distance from foundation_. ---------- Distance to nearest lot line��_--___._____ Number of lines----- --------------------------Length of each line---- '---" -� '-----.Width of trench._,/,j.e-----,----------------- Type of filter material___1&&_c-----------Depth of filter material___ l.------------------- length-----------x- _ ?______________________ Seepage Pit: Distance to nearest well_____ ____________Distance from foundation---.--------------..Distance to nearest lot line----------------- El Number of pits Lining material------------------------Size: Diameter-----------------------Depth--------------------------______ i Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining material __.________-___.__ ----------------- EJ Size: ___..._____--___❑ Size: Diameter------ --------------, --- - - -----Depth---------------- ----------------------------------Liquid Capacity-- ------------------- -gals. Privy: Distance from nearest well------------------------------------_____--------Distance from nearest building------------------------------------------ --------------❑ Distance to nearest lot lire------------------------------- ---------------------------------------------------------- Remodeling and/or repairing (describe)-------------------- - ------- •-•-------------------•----------------------------------•------------------------------ ----- I -------•------•------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that 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. Si ned -------------------------------------------------------- ------------------ ---- _ --------------------- -(Owner and/or Contractor) V -----------------------------------------------------c --------------------------------------------------------------Tifle----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY I 4- APPLICATION ACCEPTED BY----- ------'1~U1a-ri._ —--------------------------------------------------------..`DATE----- 7_=�� REVIEWED BY----------------------------------------------------------------------- - - --- -------------- ---- ------------------------- DATE---•------------------------------• ---------------------- - - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------- ---------------------------------------------------------------------------------------------- ----------------- ---•----------------•---------------------------------•-------------------------------------------------------------------------------- ---- - -------------•-------------•-- .I_`1 C.1�_1rS- ' - L�-�------ ------. _K_-------- ------ -f---- ------— ---- `--------- ''� -------•--------------- ------------------------------- �FlN i _ p C? - 8-iR ------------___D-R-K.........QlJ FCH_EG.K �------------------------ FINAL INSPECTION BY: .[. - - ---- --- Date------- 1 f ------ ------------------------------ 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 Tracy, California ES-9--2M . Revised 1.57 F.P.CO.