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- �� %`� . APPLICATION FOR SANITATION PERMIT Permit No. ---•. "-"- `I `a1 ANr (Complete in Duplicate) 1 ued __13.1-5-. - sc 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. 54.9. JOB ADDRESS AND Li�CATION f�_ - --- = - --------,---•-•--------.--------- ... Owner s Name-----=--- xQ -------./_ G. - lrl (r - �; --------------------------------------------------- Phone*(_!_�_Ikx__ 1 ter . ` r`�Address----- •-------- :7 -----------Contractor's Name G- '- - / i Installation will serve: Residence U61 House ❑-Commercial,. ❑✓ Trailer Court ❑ Mote f❑ Other ❑ :. . j >{ -. Number of living units ___ Number of bedrooms Number o aths _D-_ Lot size ___, - :-_ �r------------ ----------------- y1� Wafer Supply: Public system ©Community system E] Private ❑Depth to Water Table `_-- ft. 1 Q\1 Character of soil to a depth of 3 feet:.' Sand E] Gravel E3 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe;[, Hardpan Previous Appli ation Made: Yes ❑ No Ht New Construction: Yes S] No ❑ FHA/VA: Yes ❑ No ❑ �3 TYPE OF IN5TALLATION'J'AND SPECIFICATIONS: (No septic tank or cesspool permitted[.if public sewer is available within 200 feet.) ?- f Septic Tank: Distance from nearest wellAP*A/ _Distance from founclationl<,---------_-.Material--oz-11-Y,", No. of compartments__-- ------- Li uid depth------- - --.Capacity.._.GP� Disposal Field: Distance from nearest well/'., �'�� i ' .t- !Distance from foundat+on __.D�iance to nearest lot line___ p 14 Number of lines_F:__�__ ¢Length of each line__________- _;i_.� __Width of trench_ ------------------------- Type _ --_._-_- ,sem -- LJ - ,--l-- '--- Type of filter material_ t r-- ___:_Depth of filter maferial--_�__er. ------------Total length-:_. . -_ Seepage Pit: Distance to nearest elle._ [ __,Distance from foundation_______..-. __.Dis'han�e to nearest lot line-_`, --- -Lining Number of pits �_-:-nn _ ___ Lining material/�.�f„�y`.�Size. Diameter__�ca�..__--___Dept h__.:�.c�_�T--------------- -V yR :ter Cesspool: from nearest well __,_______':Distance'from .founclation--------------------Lining materiel--------------_...._-;,._a----------- •0 S Diameter---- .Depth- - Liquid Capacitygals, Privy: Distance from nearest'wefl_._._ r”" "--~'--"-I---"^t---------Distancei;rom nearest building-------------------------------------- _ ❑: �.,� Distance fo;ga�est lot line-:_ k - Remodeling and/or,repairmg {describe•): _..- _ _ .__ Ltt - ' r""'-_ ' Wit.fJi --- 4! �'r <! -- �`� ( -�.- -===s1 '' � � err-- ------ - ✓ / I----- -----------------------------------�_-__----_---________-_-----_____--_---_-_____-_-.----_-_.___--______---__.-_-__-_----__- ----____._-_---.__-_----:---_-_.----__-_-_.___ -___-_:---_---_--___ I herebycertify that I have prepared this application and that the work will be done in accordance with San'—� ordinances, State laws,fi and rules and regulations of +he San Joaquin Local Health Dis+rict. E` �{ � .4 (Signed}_.�f �f- �I � -- -"f'---------------------------------------41 r ----------- -------- - ---- ---------(Owner a, Plot plan, showing size of lot, loco+ion � � - , , `f � � +... Tale ( p g -of system in relation to wells, buildings, etc., can be�placed on reverse side). I � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- - ------ ------------------------•----------DATE- =--------------------------- ------------------ REVIEWED BY-------------------------------- ----------- e< # = - DATE----- --------------------- ,. s BU1LDlNG PERMIT ISSUED {- =- -�--- - - ------1 DATE Alter .ions d/or recom ends+ion / f tid _ •------- `j' :----- ------------------------------- -_ - --- ------ - P X --•---------------- J �- -- -------- -- 4 f ., ' --------------------:-•------ - '" f----= ----- ---•--------------------------------------- '� t� Z - ------ -------------------------- FINAL' •INSPECTION BY:._-- ' `_ _�_ Date----------- .--_ � , - 5AN JOAQUIN LOGAL,HEALTH,DISTRICT 130 South American Street 300 West Oak Sheet 132 Sycamore Street 844 North "C" Street Stockton,',.California Lodi, California Manteca, California« Tracy, California ES-9-2M . Revised 1.57 FRCO.