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APPLICATION FOR SANITATION PERMIT Permit No. .��_l1.______., (Complete in Duplicate) Date Issued fA�--___ u 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, Roosevelt JOB ADDRESS AND LOCATION -1$ H - lt a 0 Ckton Owner's Name----------------------------------------------------L i-oi1 lyd------------------------ --- -- --------------------------------- Phone------------------------------------ Address Contractor's Name-------F>AM H---INCs----------------------------------- - --------------------- ----------------------------------------- Phone----AP- 696Q7------- - Installation will serve: Residence [I. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A___ Number of bedrooms _____3 Number of baths ___1__ Lot size ------5Q,--------- ---la5E----------------- Wafer ----- -------_---Water Supply: Public system OXCommunify system ❑ Private ❑ Depth to Water Table __54 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U Hardpan ❑ Previous Application Made: Yes ❑ No IX New Construction: Yes ❑ No [J=,FHA/VA: Yes ❑ No ❑ Supplementary TYPE OF INSTALLATION AND SPECIFICATIONS: Drainage. (No septic tank or`cesspool permitted if.public sewer•is available within 200 feet.) Septic Tank: Distance from nearest,wel1__X0ne__bistance from foundation__r---------------Material------------------------------------------------ E:=in _____________________________________________E: tai✓#. g No. of compartments-------------------------Size--------------------- - -- _ Liquid de�th--------------------------Capaci ty----------------------- M --------------- ----- M �SDisposal Field: Distance from nearest well----NOne-Distance from foundation_____1D ._-___. nce to nearest lot line---15_t__--- ] Number of fines-------I----------------- is -------Length of each line------1081prox--.Width of trenth---------2�E---------.--------- -- Type of filter material___._- ►�___ �epfih4pf filter material--------�,-8«_------Total length--------].Q1__________________ \ � Seepage Pit: Distance to nearest welL__None---.---Distance rom f n a i is ante to nearest lot line--- [ Number of pits._-3----------------Lining material-------RQ�__.Size: Diameter------__3-31Depth-__2_ \ Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material------------------------------------- ❑ 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 - --- ----------------------------------------------------------------------------------------------------- -------------------------------------------------- -------------------------------------------------------•--------------------------------------------------------------------------------------------------=•----------------------------------------------------------------- a ---------------------------------------------------------------------------------------------------------------------•-------------------------------•------------------------------------------------------------------- -- - 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. (Signed)------------PARRTSH---INS"." ----- ------ -- ----- w�r,�Contractor) --- ---- B IY ------ -- --------- -------------------{Tit el----- Y (Plot plan, showing size of lot, lot ion ysfern in relation to wells, bu din s, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - DATE------ ----------------------- j REVII=WED BY - DATE--- j BUILDING PERMIT ISSUED--------------------------- ---------------------------------------------------------------- DATE Alterations and/or recommendations_______________ ----------------------------------- -r -------------�'-1.T.-- �?-�L� 25 �.y- � S Ff�Qr ------ avniDl-?Tc-a-t ---------S-----------RQt............. -------41t F_-- -------------------------- --- ------------------------------------- ----------- ---- -- -----------------iv FINAL INSPEC N BY: - Date-_-- 5__- .. _ 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 Revises 1-57 F.P.CO. N