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;1 APPLICATION FOR SANITATION PERMIT Permit No. ._` _ _ (Complete in Duplicate) q Date Issued Dmss—?s0 —33 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 compiianee,with County Ordinance No. 549. JOB ADDRESS AND LOCATION-- 10 -ane, �- 4� 2e _---ft Owner's Name______ ------- �'1' ---- ---------------------------------------------- Phone------------------------------------ Address ---•--- •------------- -------•--- Address---------1-74 ---- Contractor's Name ---- - --- -------------------------------- - --------------------•--------------------•--- Phone----------------------------- Installation will serve: Residence U�- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of bedroom _ - Number of baths __Z Lot size _ __ ___ . t _______________ ___.___ Number of living..units: _/ _ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table Character of soil to a depth of 3 f e:Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No'PEr *New Construction: Yes PROI ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 'I (No septic tank or'cesspoolpermitted if public sewer is available within 200 feet.) F , J Septic Tank: Distance from nearest we!!_ Q _ Distarlce f om foundatpn___/ --------Material_____ : ___- _____---_-, [� No. of compartments__----- - _.___Size_ /0___t�__VALiquid de th________4- ---------Capacity Disposal Field: Distance from nearest well �pv-----Distance from foundation--/ Distance to nearest lot line_,=ye--- -- �• Number of lines:`______ ____ •� �.__ _�_._- ______ Length of each line��`�`s�____'_�_�a�Width of trench..___ -_- .{� � •. - - �--------------------- Type of filter material_/__�. Depth of filter material---l�__s�_-----Total length-____Z.I------------ -- --- k4. ., e Seepage Pit: Dis#ante to nearest well---4,l �_ _-Distance f m f dation___, _ __.__.D. n�c� to nearest to line__+ Q0` Number of pits.!_! �-------___Lining material__.4 _ -----Size: Diameter--- ------------Depth---.- _----------------f Cesspool: D-stance from nearest well_-___� ______._Distance from foundation___________________Lining material___._-- __________.___-._-________._❑ Size: Diameter- --------------------'`-�-----.Depth----------------------------- ----------- ----------Liquid Capacity-------------------------- gals Privy: Distance from nearest well----------------------------_-______._____._.__Distance from nearest building----______________________-_---------_ ❑ Distance to nearest lot line--------- ------------------------- - ------------------------------------------------------------------------------------- Remodelin and/or repairing {describe):-_-:___._- - -, 9 _ -- -------------------------------------------------------------------------------------------- ---------------------------------------------••----- --------------_-----------------------------------------------•------------------- ----------------------------------------------------------------------------- -- ------------------------ -----------------------------=---------•----------------i__,__7------------------------------------------------------------ -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul s and regulations of the San Joaquin Local Health District. (Signed)------ ------ - ---- ---- —-------------- ---- ----- ---------------------------------------------------(0-wiver-a9Gor Contractor) °-- -_-- -- -------------------------Title__. __ .r (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----T-R0---------------- ----------------------------------------------- DATE----- REVIEWEDBY-------------------------------------- -------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------- ------------------------------------------------------------- DATE Alterations and/or recommendations: -------------------------------------------------------/-----------------------------------•-------------- ---------------------------- ---------------------------------- ---------_-?tl------T-E-PTH�--------2�---------0�_--------11 R p--------�~_z�-- --------------------------------------- ---- - --------------------------7-------------------- -------- -------------- L __ - _: NAS ------RA ---- FINAL INSP - -- - -- - - --'----- ------ Date--------- k. SAN JOAQUIN LOCAL HEALTH DISTRICT r 1 130 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 FICO.