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APPLICATION FOR SANITATION PERMIT Permit Na. (Complete in Duplicate) Date Issued 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_-_---___--4_3 q W, - -L-_ I— +h--------------- ------------------- Owner's Name----- S- ----0-- �'�---V.&.e------ u --------------------------------- ---------------------------- -------.-- Phone/20------70----------- Address---------------------- 3-- --------------------- ----- - --------------------- ------------ Phone- --- h Contractor's Name ------ c>re Installation will serve: Residence M—Apartment House [-] Commercial E] Trailer Court F] Motel 0 Other E] Number of living units. Number of bedrooms __9:7.'Number of baths r__/_-- Lot size --- Wafer Supply: Public system Community system El Private El Depth to Wafer Table dd'ft. Character of soil to a depth of 3 feet: Sand E] Gravel ] Sandy Loam El Clay Loam El Clay El Adobe 2` Hardpan E] Previous Application Made: Yes El No New Construction: Yes El No L] FHA/VA: Yes El No [I �; N TYPE OF INSTALLATION AND 5PE61FICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearesfw6l-----------------Distance from foundation___-________--_-_-Material______________________________ F --------------------------------- No. 'of'compartmenfs----------- ---------------Size-------------------------------Liquid clepth-------------------------Capacity----------------------- Disposal Field Distance from near t 11ARONE!---Distance from foundation--- Distance to nearest lot line_47,.0 r Number of lines Nurr _-T-w-e---- --------------Length of each lineP-0 Width of french.-A-Vol/ 4- Total length--------------�kQ7---_ Type of filter maferial-'p—Sk"r__-Depth of filter material- -Seepage Pit: Distance to nearest welIJAKLO-------Distance from joundatio n---VS-__.`.__.Disfance to nearest Jot line-----��7_`__ Number of pits....I----------------Lining material---Rmoice.!-% -,.,I Af r S e: Diameter---.3-15--------- C� P Depth------ ----------- Cesspool: Distance from nearest well-___-__-_ _Distance from foundation--- ----------------Lining material"_..--__---_-_- ------------------- Nl El Size: Diameter-------------------------- -------------Depth------------------------------ ------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-- ----------------------- ---------------------Distance from nearest building------------------------------ El Distance to nearest lot line Remodelin )e): ------- -- ----------- ------- % 4, ----------------- ------- -- - ---- A --------- ------ -_. :-----7— - ____p------- q_ -----&------- ------ -----------------------------------------------------------------------------------L-V-------------------------------------------------------------- -------------------------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State,, fy and rules and r ulations of the San Joaquin Local Health District. (Signed)----1,fn ---------- ------ ----- ---------------------- By:----------------------•-------------------------------------------------- ----------------- - -- ----- ---- - --R*_ _—____(Ti+Ie) (Plot plan, showing size of lot, location of system in relation f e ! buildings,yc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- - --------------------------- DATE g REVIEWED BY -------- DATE -- - ---- BUILDING PERMIT ISSUED--------------------- -------------------- ---------- 4 ------------ DATE Alterations and/or recommendations:---- -- s b i ---- ------- - ------------- ------ 14 -F _ 4�5-----r--i 6---- ------------------------------------------------------------------------------------ • ---------------------------------------------- --------------- --------------------------------- - p ---------------------------------------- ------------------------------------ ---------------------------------------- ------------------------------------------------- -------------------- i l 9; in_ - FINAL INSPECT) Y., Date----- 12 - ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 7 130 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 , Revised 1.57 U-CO.