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F APPLICATION FOR SANITATION PERMIT Permit No. _ 11_a l--`4- [ (Complete in Duplicate) �J Date Issued3S _y' _` - � 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. '- JOI? ADDRESS AND LO 40N__.-------��y �i�� " j-� --------------------------------------- Owner's Name- �C-'�-------------- � C -LCA ---------------- Phone Address--------- ---- ---- -- -- j Contractor's Name !-[.- a,24_?- ta.4-/ _ Phone.. a�`ab --------------------- -- �-- ,_,..,� ------------- ---- Insfaiiation will serve: Residence M npartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ 11 Number of bedrooms Lot size f-- �- Number of b !--?4 /r�-�---�--•�--��---/. -------- Water Supply: Public system ❑ Commuriit s stem Community y ❑ Private epth to Water Table ��_ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;�,_ Cl oam E] Clay [-] Adobe Hardpan El ' Previous Application Made: Yes D No ew Construction: Yes ❑ FHA/VA: Yes ❑?.No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' SepticTa Distance from nearest well____ Distance from foundation_ �_____-_-__.Material_i_C _No. of of compartmerifs----s�-__ ----------------- Size X-�-� Liquid depth -r--------------Capacity._�lo _a C7 Disposal F Distance from nearest well-_ Q------Distance from foundation__/l?_'__.____-Distance to nearest lot Number of lines---.----- S----------------Len Length of each line_I`o 4' �► g t 0_ ,--6---- Width of trench ---------------------- Type of filter _____Depth of filter material____l_ -----__ Total length___._1�W--!_____________ Seepage Pit: Distance to nearest welt----------------------Distance from foundation--------------------Distance t�epfk st lot line__...______-.-___ ❑ Number of Pits----------- Lining material Size: Diameter , y ---- Cesspool Distance from nearest well_________________Distance from foundation___.______,_____.Linin material ED Priv Size: Diameter Depth...... _..'-----------------------`---------------Liquid Capacity------------------------------gals. x, y: Distance from nearest well _ ____ _ I ____________________Distance from nearest building______- -__________---____- Distance to nearest lot line. -______._______________ -------- --------------------------------- Remodeling and/or repairing (describe): _-zzt� � � --- - ---------- --------------------------------------- -------------------------- -------------------------•-----•---------------------------- ------- ---------•--- --------------------- ------------------------------------------------------------------------------------------------------------- ----- --- --------------------------- ------------------------------------•-------------------------•-----------------•------ ---------- --------------------------------------------•------------------ 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 istrict. (Signed) �•�!Z1---- ---- � �a-c-f P2 (Owner- - rand/or Contractor) By:--------------------------- - - - ----L-- --- � j- -----(Title)- _/ -�- -----_.------- (Plot plan, showing size lot, Iota ion of system in.relation to wells buildih gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•-1__r_l ------ DATE ED BY --- --- ----- ---5� -- ------------------------ ------------------------------ ------------- ------------ ------------------------------------ DATE------------ --•---•----------•---------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:---------f_-------______ I -- ----- - -- --------- ---------------•--•------------------------------- r -- A- --- ------_815;4k_[? rr--------- -13_.13-.---- ---------------- --------------------------------- ------------------ --------- -- ------------ -------9_� = -----.----.----------- ---------- ----- -------------- --------- ------------------------- FINAL INSPECTION By_ --- '- ----�--- Date--------- " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, Celifornie Manteca, California Tracy, California i ES-9-2M , Revised 1-57 F.P.CO `S – =