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a 'APPLICATION FOR' SANITATION PERMIT Permit No. _l4_ (Complete in Duplicate) y� Date Issued --- 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 Ord• nce No. 549. JOB ADDRESS AND LOCAT NJ__ Owner's Name _____ 4F I D__7- ----------------•-- ---------- r---------- F -- ---- ------------------ - ------------------------------------'-- Phone-------- Address-------------------- Contractor's Name ------•---------------------------------------------------------------••------- _.---"-_--- -- -_ � -----•----'-------------• ------------------------------------------I_ Phon nstallation will serve: Residence [47(partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. Number of living units:T Number of bedrooms C? - Number of baths __/ Lot size ___�"( _-- _ ❑ .41 Water Supply: Public system ❑ Community system ❑ Private [ epth? to Water"Table/-ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑' Sahcly Loam ❑ ClayLoam Clay❑ y ❑ Adobe �rdpan ❑ Previous Application Made: Yes ❑t No N ew Construction: Yes .❑ No ��HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) p i ank' Distance from nearest well_______________ a _Distance from foundation-------- ._____.____""""-_"_"•,"_-"-""_-"--_-_"-- No. of compartments--------------�---i--Size"--------------- -----------Liquid depthol I Capacity - Disposal d: Distance from nearest well_-_0.Q._----Distance from foundation•-,5_0---------Distance to nearest of line-----$---- Number of lines___._ - _. _- Length of each line6_v-______�Q___".Width of trench_. _ __ -----__ __ Type of filter material ' epth of filtermaterial__ Xg - Total length-------•---------�D_` ----------- Seepage Pit: Distance to nearest well--------------_-------Distance from foundation____�'-"_"_"Distan�e to nearest lot line_____________._ ❑ Number of pits.--------------------- on material-----------------------Sizer Diameter----•---------_" ' -----------------------Depth------- ----------------------- Cesspool: Distance from newell--------- anceromoundation___________________Lining material____-_________-" -___ . Size: Diameter--., --- ------------ I i----------------------------------Dept k--------------- ------- ---- ---- ------Liquid Capacity--------------------------- gals. Privy: Distance from narest wel-------------------------------------------------- sDistance from nearest buifdin El Distance to nearest lot-line------------------------------_ Remodeling and/or repairing (describe): ----------------- -=--------------------------------- ---•-- ----------------------------------------•----•---------------------------------- -----------------------------------------•-------•------------------------------------------------------------------------------------•-------•--------------------------------------- I hereby certif that I have prepared this•..application and that the work will be done in accordance with San Joaquin County ordinances, a s, and rules and re ulations of the San Joaquin Local Health District. (Signed)------ --- e ------------------------ �-- !.�/ ------- By----------- ----------------- Cont tar� - -. - Owner and/or vac 11 {Title) (Plot plan, showing size of lot, location of system in relation to wells, b ' gs, etc., can be placed on reverse side). * E .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------- DATE- -------------------------- ----------------------------------------- � REVIEWED BY-------------- ---------------"---- ----=.-- ------------------- ----------------------------------------------------------- DATE---- --------------- ------------------------ BUILDING PERMIT ISSUED__________ I ------------------------------------------------- --------------------------------------------------------------------------- DATE- r Alterations and/or recommendations__ ________________"__.___._ -----" "-____-" -------- ------------------------=------ -------------------------------"-----------"---------------------------------------------------------------- ---•----•---------- ------------------•------•--------•-----------------------------------------------------•------------------------------•-------------------------------------------------------------------------------- --------------------------------------- FINAL INSPECTION BY:_.____ �'�`��-------------- ------------- -------- Date--------�'- fj---------- 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 FRCO.