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� u. j� APPLICATION FOR SANITATION PERMIT Permit No. � ___ _. �: . �/71 n-m (Complete in Duplicate) f Date Issued _�___�__ --*0_ 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 c6 mpliance with County Ordinance No. 49. JOB ADDRESS AND LOCATION-.. l ` eA ' - y ----------- �t----- !/!✓.2�«+?� �% I tf� -------------•----- -� -----fi t _ --------------------------------------- Phone------------------------------------ Owner's Name----�--------�-(- !.�-tx,---��'---•------- ---•--- •------ - ------ - - - - Address-------------- '----- 1 L---6?t - ---- ----- "'` ------------- -------------------------------------• '------------------1 _244-- ------------------ 24 i-- Contractor's Name---------------!� & --------- `' �_4 "7_ ZZo_0�. � - Phone Installation will serve: Residence ®Apartment House ❑: Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____��r Number of bedrooms 1______ Number of baths _�__'__ Lot size __.__ a__1_'�___-�-:��______________________ Water Supply: Public system 2--60mmuriity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [�H`ardpan ❑ Previous Application Made: 'Yes ❑ No D---New Construction: Yes ❑ No 2`__FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance!from nearest well_________________Distance from-foundation____-__._________-Material_______-_____.__..___________________.______._. ®-ra EJ' No. of c11 mpartments---- Size- Liquid depth Capacity F ;oral Field: Distance��from nearest well-.�kr5.___.Dlsfance from foundation___________.__.Distance to nearest lot line____ __-------- N umber _______Number of lines------- __ Length of each line___'__ ___!________.Width of trench.__ t!------___.__________ S Type of filter material___ "v �.-_________Depth of filter material____L9_____________Total length_____�t_____________________________ Seepage Pit: Distance �to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________. -_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth----------------------------_--.- I Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining material_____________________________.______ R\- Size: Diameter______________________________________De th Liquid Ca acit gals. ❑ p _ ,- q p Y —- Privy: Distance from nearest well________ _______ _____ _ ____ ________Distance from nearest building------------------------------------------ El __._____ _ __ ____ - ___.❑ Distance4o nearest lot line------------------------------------------------------------------------------------------------=--------------------------------------------- Remodeling and/or repairing (describe :---- -, ------------------------------------------------------ ----------------------------------------- -------- ------------------------------------------------------------•---------------------------------------------------------------------------- ----------------------------------------------------------------------- --------------------------------------------------------=------------------------------------------------------------------------------------•---------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the. San Joaquin Local Health District. (Signed}___________________ _ _ ___________-(Owner and/or Contractor) 1 - ----=� By:------------------------------- 1........ -C----------------------------------•--------------I--------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, Wation of system in .relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY nt.t APPLICATION ACCEPTED BY------ t -�1r�>----------------- -- 1.1 DATE ? -- — --------- REVIEWEDBY------------------------`--------- -------------------------------------------------------------------------------------- DATE--------------------------- BUILDING PERMIT ISSUED--':-----------------------------------------------------------—-------------------------------------- u DATE------------------------------------------------------------ aerations and/or recmmegdations:------ ------------------ -- ----------•-----...---------------•------------------------------- --- ---- - -- ---- -•-.---4E16�1-:----- _ r ----------------------•--------------- ---------------- --------------•--------•--_------------------------ -------------------------------------- ---------------------- ------ ------------- ----------•----TP,v_v ------Vim----- ------------- -----------------------•------------------------•--------•--- •-----------• - Me Z__11, ------•--------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- r ----------------- - ---- - ---------- ------------------------- _ :� FINAL INSPECTION� BY 6 �. Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2 M1 , Revised 1.57 F.P.CO-