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k. APPLICATION FOR SANITATION PERMIT Permit No. _ �-5. _.... (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health DistrictW549r ermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. I JOB ADDRESS AND LO ATION______ - -- _�-_ �-.: -- Owner's Name--------- �..�f ------------------------------------------------ - -- ----------------------------------------- Phone----------------- Address.--------- --- --------•- ----- --------- ------ --------- Contractor's Name P/J ------------ Phone-----•--••----------- ---- Installation will serve: Residence [4—Apartment House ❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other ❑ 1. Number of living units: _4___ Number of bedrooms -&?-.. Number of baths`-_,/-_ Lot size ___,11 � Water Supply: y pp y: Public system �Commuriity system ❑ Private ❑ Depth to Water Table _r)_fs,9lt. Character of soil to a fdepfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq-'Tlardpan ❑ Previous Application Made: Yes ❑ No Z�'- New Construction: Yea ❑ No' R�'FHA/VA: Yes ❑ No (_ ` TYPE OF INSTALLATION AND SPECIFICATIONS: +. (No septic tank or°cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr well_�__0_f__Distance flrom foundation__�7-_f_-_-Matefia�___ _e-- _ ' No. of compartment's____-A___________ __Size_�`�l�_� 1j�f1___Liquid depth__ __ Capacify-_19-ILI --- Disposal Field: Distance from nearest well_�49-----Distance from foundatior`,X;! ----- Distance to nearest lot line__ 1__-._ ( Number of lines____-_-/_________ ______ ength of each line-----b�__�__- _-______.Width of french----- Type of filter material__,_ 11 Depth of filfer material__-- -----------Total length___-- ` -_� See a � -- � i � / -- --- p p ge Pit: Dis#ante to nearest well___, ��__ ___Distance from foun tton_-_. �__. -,Distance to nearest lot line__p_ f ----------- Number of pits._._------------Lining material/ ize: Diameter--,.� _�� -9 ----.Depth----. a �1 R Cesspool: Distance 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 fot line------_----------------------------- - -------------=------------- ---------------------------- 00 Remodeling and/or repairing (desc -------------------------------- ribe]:_____._.. -------••----••------------------- ---------------•---------------•-- -•- ------------------------------------------------------------- ------------------------------------------- -------------------------------------------------------------------------------------•------•-------------•------------------------------------------------=-•---------------------------------------------------------------- ------------------------------=----------------------•----•------------------------------•-----------•-------•-----------------------------------•-------------------------------------•---------------------------------- 1 I hereby certify that I have prepared this application and•thaf the work will be done in accordance with San Joaquin County- ordinances, State laws, and rules and regulation of the San Joaquin Local Health District. (Signed)------------------- } - -- G+Maaor Contractor) By - �ionof ---- --------•-----------------------------------(fit le)_- -�---------- (Plot plan, showing size of lot, l stem in relation to wells, buildings, efc., can be placed on reversee). { FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY----- }•-------------------- - ---- -------------------------------------------------------- DATE------- --- - - - - --- - ---------------- - ----------------- REVIEWED BY------------------------ ----------------------------------- --- --------------------------------------------------------- DATE- 4 BUILDING PERMIT ISSUED DATE Alterations and/or recommendations----------------------- ------------------ t --------•-------- - ". . , - -------- ----- ---------- ------ ---------------- ---------------r---- --------------- --- ------------------ --------- ------------�--------------------- FINAL INSPECTION 13Y:. Date---- = V�7 ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street r 300 West Oak Street 's 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 f_P.Co-