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APPLICATION FOR SANITATION PERMI� Permit No. (Complete in Duplicate) Date Issued --- -PA 7- Application is hereby made to the San Joaquin Local Health District for a�*rmif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A ^ OC TION ---•---------------- 2- Owner's Name__ _ _ --------/------ 71�,h------------------------------------------ -------------------------------- - Phone ---------- Address_______�91/ 2/0 Contractor's Name________..___________ - ---------------------------------------------------- ----------------------- ----- Phone Installation will serve: Residence tg, Apartment House El Commercial F] Trailer Court E] Motel F]. Other E] Number of living units: J__.__ Number of bedrooms -2- Number of baths ___I_- Lot size ----;?-15— Water Supply: Public system El Community system El Private j2L Depth to Water Table,?O-. ft. Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy LoamjX Clay Loam E] Clay El Adobe I—] Hardpan Ej Previous Application Made: Yes , No El New Construction: Yes 0 No SK FHA/VA- Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Ta faz�c 7m are well isfp cero andio L ;,�ae -a Ke- e ------- 'a ify Disposal Field: Distance from nearest weiI-y?)--Distance from foundation___-/D---------Distance to nearest lot line ------- )IL Number of lines--- --------Length of each line--- -------Width of trench---- -v�- ------------------- Type of filter material _,1414-14-_------De th of filter material____. ------- Total Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.--Distance to nearest lot line____________-_.._ ❑ ine----------------- F-1 Number of pits----------------------Lining material-----------------------Size:Size: Diameter------------------------Depf h--------------------------------- a ty- Cesspool: Distance from nearest well__._____._____Distance from foundation------------------- Lining material-.______________________--------------------------------- 171 Size: Diameter------------------------- ------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals.- Privy; Distance from nearest well-------------------------------------------------Distance from nearest building____________---_-_________ - F1 Distance to nearest y lot line---------------------- P Remodel 8 -------------------- --------------- ''/cir repairing (describe}:- /7.2 T----------------- Remodeling andL41&A(2------- d—.1--- - C c", -------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------:--------------------- ------------------------- -------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ----------------------------------I-----------------------------------------------------------------------------------------------------------------I----------------------------- is application and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared Al (, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- LTJ----_ --------------------(Owner and/or Contractor) r By:-------------------------------------------------------I------- ------------------------------------------------------(Tif le)-------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- --- - ---- --- -------------------------- DATE----- REVIEWED BY-- ---------------- --- DATE---- ' BUILDING ATE----- BUILDING PERMIT ISSUED------------------------- - - DATE.------ -- -- --------T-?- Alterations and/or recommendations:--------------------- ---- --- --------------------------- ---------------------------------- 7 ------------- ------ - --- ------------- --------- ---- -- -- ----1�-- --------- 7 ------------ --- - --- ---- ------ ---- ------------------------------------------ --------------------------------------------------- -------------:-------- -------------------------------------------------- ---------------------- ------------------------------------------------------------------- ------------------------------------------------------ --------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- ------------------- --------------------------------------------------------------- 2 e' — FINAL INSPECTION BY:---------f ------ - - -------- ---------------- Date----- --�J-��------ ----------------------- l SFAN JO 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 Revised 1-57 FT.00.