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-1 APPLICATION FOR SANITATION PERMIT q D V l `� Permit No. li (Complete in Duplicate) -'---•• Application is hereby made to the San Joaquin Local Health District fora ermit t _ Date Issued ._?V. /S_ This application is made in compliance with County Ordinance No. 54 . p o construct and install the work herein described, JOB ADDRESS AND LOCATION_-_-- Owner's '. Name---•------- /-7---•-- - Address-.----- --d•-�-----------�•--rf',t�_ -,-------------------- ----------- ------------------------- ---------------------•---------------- -------•-----••--•----------�-------�•------_-.-.-_- --------- ---•• ----- ----.- Phone.__�- r, Contractor's Name _,�---__---- ��-✓�•. ' - --- ----- --------- Installation will serve -------------- : Residence partment House Phone------------------------ --------- Number of livingunits: - ❑ Commercial ❑ Trailer Court ❑ Motel ,/�--- Number of bedrooms - ❑. Other [, _ Number of baths _.L Water Supply; Public system �] �ommunit system --- Lot size _ � - r- --- __ Y Y ❑ Private" Depth to Water Table �/ Character of soil to a depth of 3 feet: Sand "� ft. Previous Application Made: Yes ❑ Gravel [f Sandy Loam ❑ Clay Loam ❑� No ❑ Clay ❑ Adabelardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:Construction: yes No ❑ FHA/VA: Yesvo (No septic tank or'cesspool permitted if public ewer is available within 200 feet.) Septic Tank: Distance from nearest well _Z Distance corm f undation-_-- No. of compartments-----�._- -_ ------.Mate�a�--( Size__ - Liquid depth---- Capacity ------------------ Disposal Field: Distance from nearest well-1,Q_--_Dis}once from foundation-- Number . Number of lines- _- i�._______________ __Length of each line_ Distance to nearest )of line--- 4---- ' ---------------Width of trench._--�_ --- Type of filter material -f_ JeP0 Depth of filter material-----� �! __Total length---- - -- ------ - Seepage Pit: Distance to nearest well--- / �'7 r�e� ...... , - _Distance from foundation---- :_.Distance to nearest lot line----�- i Number of pits.--._- -_- -----Linin maferial_/4 ,p Cess ool: g -'iv�ize: Diameter'_. �� fr -- Depth .................... ❑P Distance from nearest well_--______-___- Distance-from foundation.._--_:-_ _ Size: Diameter-__-- -:_--- Lining material------- _ - -Depths------ ----- ------- - �-y Privy: _Distance from nearest well----- --__- - Lrquid Capacity- --------------------------gals. ------- ---"-._Distance from nearest buifdin Distance to nearesf-lot line--------------------------' ` ' .. , 9 Remodeling and/or'repairing (describe}:---- ------ ------ - --------------- -------- --- _. ,, -------------------- -------------------------- -----------------------------------------•---------_-. -------------------------------------------------- m 1-_ � r . I'hereby certify that'i have prepared this application and that the work will be done in accordance with San Joa qui Cou ordinances, State.laws, tact. 9 Local Health District. and rules and regulations of the San Joaquin L ' �`"`� 1 y (Srg ----- --------- - �� : ------------------ -•------------------- y �iono ----- -- - .. Trtle (Plot plan, showing s*iz�e of ]oto to ystemin relation to wells, buildings, tc.,..can placed onreverse side). ------------------------------------------- e. _. e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- r , --"^_1 ---'------------------ __--------------.--- DATE REVIEWED BY-------------=- ------ ------ --- ----- ---------- M --------- � --- UlLDING PERMIT ISSPJED------------------------ ---------- ------ - ---- ------------- L L(��-- ----------------------------- ---------------------- DAT ------ - ------------------ Alterations and/or recommendations:---------------------------- DATE-__---___._._ ----------•-- -------------- ------------- ------------ --- -------- ------------ ----- ----•- :- •----- --- ---- ,.. . 4--•--- "-----------------------------". - ---------I-------.--- - ---------- --------- - -------- ------ --- ,_F1NAL INSPECTION BY: G�- ------------ Date_------ r SAN.JOAQUIN LOCAL HEALTH DISTRICT 130 South American$tree+ E �\300 Wes+Oak-Street Stockton, Califo_rnia"- i 132 Sycamore Street ; E14 North "C" Street 11 Lodi, California Manteca, California ES-9-2fv1 , VTracy, California Revised 1.57 F.P.co. l