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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �`� j q Date Issued ---.L--7_____,!__ 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. JOB ADDRESS AND LOCATION-,1.45"a4--------------�-- -- - ----------------------------------------- Owner's Name----------------- `F -=Ctr'�t -------- (------------ ------------------------- ------------------------------------- Phone, Address = ---`------------------- - Contractor's Name '*'- f r � �---7 ` ----------------------------------------------- Phone.g-- Installation will serve: Residence M Apartment House ❑commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Nurnber of living units: _ Number of bedrooms____ Number of baths-_ Lot size ------/S—D---_---x___--_ ________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _J ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobep( Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No)R�_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200'feeet} i �a S is Ta Distance from nearest well________________ Distance from foundatiLiquidrdept Material___.________-.-__._______-_____________-_______. No. of compartments----------------------- -Size---------------- h--------------------------Capacity-------------- -------- c'I' '' p'____Distance to nearest lot line_______ Disposal Field: Distance from nearest well--1-_-�Distance from foundation______- _ _ _ Z Number of. lines__-__�______-_ -\_____-___Length of each line---- "7; Width of trench____Sr Type of filter material____ _ --------- of filter material-----/----_______Total length_7Z__�________________------_________- AIC - , -• Seepage Pit: Distance to nearest we1L_tsv_-_V-%—_____Distance from foundafion___,ZP._:____Distance,to nearest lot line---- Number of pits------2--------__-Lining material_-mrJ --------Size: Diameter---_5 3_ .. Depth- --`------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- material--------.___--------_______-__-______- Size: Diameter-------------------------- Dept $_-Liquidh----------------------------------------------, Capacity.. gals. Privy: Distance from nearest well-------------------------------------------------Distance from neares+ building---------------------------_--_--_____-_. ❑ Distance to nearest lot line------------------------------------ ---------------------------------- ---------------------------------------------------------------------- 7 --Remodeling repairing (describe):---- / * \� and/or re ai ----------------------------------------- f ----• -----•------= ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have-prepared this application and that +he 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) `� '#C`'t l _-�> ` l �� -� f ! --------------- ------.( Contractor) Sy:------------ /r`"' ` ---------(Title)-------------- ---------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation o wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------" ,.R ' '---------------------------- =----------------------------------- DATE------ 7-------------------------- -- REVIEWED BY----------------------------------- ---------------------------------------------- ---------------------------------------- DATE-------------------- ------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------- _= = ------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------=-------------!--------------------------------------------------------------------------------------------------------------------------------------- '--------- .P ice'._._._ _'TNS 's _ f --------------------------------------------------------- ------- ----� ` I------------------------- --.I------------------------------------------------------------------------------------------------------ ----------------------------------------------------- -- -- -------------------- -------------------------------- j FINAL INSPECTI�SN,Y- Date---= "7-_Z--57_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-211A ReviseG 1-57 F.P.CO.