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APPLICATION FOR SANITATION PERMIT Permit No. .__ .-L-. _ ____ (Complete in Duplicate) 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 Ordinance No. 549. 3 JOB ADDRESSAND LOCATION__At---9-z------ 01 --- "_ -t/E' ff Owner's Name � 1 + - .OQ47 --- ------•------------------------------------- - -----------------------------------•--- __4 --- Address -----------------------------------•------- ----- P Contractor's Name----- * "' ��`"---------------------------------------------------------------- Phone----•-----•--------•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Fj Number of living units: j---- Number of bedrooms —*--- Number of.baths Lot size ____ -�___ ___�2 _________ ___________ Water Supply: 'Public system ❑ Community system ®, Private ❑ Depth to Water Table l<®_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ - Clay Loam ❑ Clay ❑ Adobea Hardpan ❑ Previous Application Made: Yes ❑ No & New Construction: Yes 4 No ❑ FHA/VA; Yes N3 NoK TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__/Vt-_&�Distance from foundation.__-�Q__ --_--.Materiai____C-G__� �J No. of compartments-------__aD___-------------Size__ Cc__ .>!..___Liquid depth---- :5_77,i _____Ca acit !�r4�________ Disposal Field: Distance from nearest well_wn-,7 istance from foundation-----Iq---------Distance to nearest lot line------ ----__L_ Number of lines-----------:Z-------lz_______Length of each line------3_-7_1 ----------Width of french------�-�--��,-_- ------ Type of filter material___ -____5-eZDepth of filter 'Material-------- �___ _ _ Total length--- __________________ Seepage Pit: Distance to nearest well-_A /471,4,Distance from foundation---- r(2.......Distance to nearest lot line.... Number of pits_______ _____________Lining rneteriai---AC>L. '�---Size: Diameter__--. - . ___.Depth__.._ .` _ _.......... W , Cesspool: Distance from nearest well------------------Distance from foundation------------_------Lining material_,------------------------------------- O ❑ Size: Diameter--------------- De.p+h--- ---------------------------------------------_Liquid CapacifY- - ------------------------gals. ) Priv Dista ce from nearest_well._.._______.._.____I ---------------Distance from nearest building Y ------ g--------------------------------------- ❑ - Distance to nearest lot line:---------------'- ;' - 1 Remodelingand/or repairing (des'ribe): ---- ------ '------------------------------•----•----------------------•------------------------ ----•-------------------- y --------------------------•------ -------------------------------------------------------------------•-------•------------------------------------- --------------•-----------•----------------------------------------------------------------•---- 1 hereby certify that I have prepared this application and 'that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. r T -74 [Signed}------ -- ------ -----------------------------------------------------•-----------------(Owner and/or Contract Y =:. ? (Title}-._ _= (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed odievel•se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY--- ---------------------------- --------------------------------------------------------------- DATE r REVIEWED BY-------- = ------------------------------- -------------------------------------- DATEy� BUILDING PERMIT ISSUED------------------ ---------------------------f----------------------------------------------------- DATE--- Ors Alterations an eco J endation --------F --- ----- ---------- --- ------------- _`-- - ---------------- ./-- -,�_..---- -10---� - - -- ----- ------------- -- -- - -- - -- -- -- -- ---------------------------- -- ----------- -------------------------------------------------------------------------- --------I---------- --•----------------------------------------------•---------------------------------------------------------------------•---- FINAL INSPECTION i3Y:---=--- Date-- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 West Oak Sfree+ 132 Sycamore Street $14 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M1 Revised 1,57 F.P.CO.