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APPLICATION FOR SANITATION PERMIT ti ; Permit No. ._/�.__tJ___,�'S. � {Complet(; 1n'Duplicate) �''� ..� bate' Issued-___._�_1_s� - -' Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta{lythe work herein described This application is made in compliance with County OD ante No. 549. 1 Q r JOB ADDRESS AND i C 10 "- G -------------------------------- ----- r Owner's Name---- � ------ .. Phone,<w- -- - Address.-- -- - " - ------------�-- - - ----------•--- ------ ------------ ----------- ---- -----• -• --- --- ---------------- -I..__... ----- ----------- Contractor's Name �,E.r �` l=r �z� r Phone__ Installation will serve: Residence '6d' A rtment House ❑ Commercial ❑ Trailer Court ❑ Motel I Other E]Number of living units: _.__I_- `Number of bedrooms ___i___ Number of baths ___/__ Lot size Water Supply: Public, system Community system ❑ Private ❑ Depth to Water Table -7--- ff. Character of soil to a epth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No-X, New Construction: Yes;, No E] FHA/VA: Yes ❑ No TYPE OF INSTALLAT;ON AND SPECIFICATIONS 1 t (No septic tans or'cesspool permitted if public sewer is available within 200 feet:) 1 ��^IF r Setic TankDistance from nearest wel I Distance from foundation__ffl______.___.Mataria_______________________-_-___._____._._____ g(� 4 No. of compartments__ __.____Size____.- -/--S_ �r Li uid de t_ :V /t r` �` q p - Capacity �LD�isp,se*ld: Distance from nearest well_ ._.Distance from foundation _____ -Dlistance to nearest lot line--- / 4 t Number of lines------r------ Length of each line____ -------------_ idth of trench___-�__,_____.__-..---________ Type of fifer materials-T_ Depth of filter material___ _ Total length________ ________________ ------- Seepage Pit: Distance to nearest well- ----_Distance from f "dation ______ _.___.Distance to nearest lot Number of pits----- ---------------Lining material -----Size: D eeter---��-----------.Dept"-_.- --------------- Cesspool: ------------- v\I '� - ---. I , g --- - Cess oal: Distance from nearest well________________ Distance from foundation._.._._.__ _ ._ Linin material Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------ga, Privy: Distance from nearest well______________________________.____________._...Distance from near bui din `-/ 9---------------------------------------- s ❑ Distance to nearest lot line___.____.____ Remond or re' airin describe :_� --- - y ---------------------------- 13 / p 9 ) - --- ------------------------- ---- --------- -- --'."""`---------- =--------------------------------------------------- ....................... ---------- --- I hereby-certify that I have prepared this applicatPn and that the wor + --------------- ------- --- - ----------- --- --- -------------------- -------------•------------------------------------------------------------------------------- - 'k will be done in accordance with San Joaquin County ordinances, Statews and-r les &regulat s of a San aquin Lod-E's ealth District. i� 57 1 (Signed' 9 ° ow = � ------ j {Title}__ {Ow d/or Contractor) i ne R L - --- ------ [PlotIan, showing's e o , locati n of system in relation to wells"buildin s etc. can be fac� P Y 9 p on reverse e). s i 1 i rk FOR DEPARTMENT USE`ONLAPPLICATY f DATE ` ------------ REVIEWED BY_-ACCEP © B � ., , :_ ' # i �. -------------- DATE ��-// ;BUILDING.PERMIT-ISSUED-------------------- DATE v ------------- i Alteraf sand/or recomm ati ns = r c- - --- ----------------- a r------ Y ----- -- -------------•-•------------------- . y 4 9 --------------------------------------------------• -----(---.-------- ------------------------------- -- --t A - - � r FINAL INSPECTION, BY:------- ------------------- ----- Date--------- l 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.