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APPLICATION FOR SANITATION PERMIT Permit No. _14.'_.tf (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.,e LOCATIDN_3 --=----------- j-------/a-CrIx...0�_T_;?.------ Owner's T_;?....... Owner's Nane-- 12 -------------__--------------------------------- ------ --------------- - - ..P hone Address---------_--------- 1 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - Contractor's Name-- Q_-�sy. )4 Phone. Installation hone-Installation will serve: ReJeince /VA J4 Apartment House E] Commercia Trailer Court E] Motel E]. Other ❑ Number of living units: _/----- Number of bedrooms Number of baths j--- Lot size _________________________ Water Supply: Public system El Community system [I Private [8,Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel 0, Sandy Loam Clay Loam [] Clay ❑ Adobe [] Hardpan 0 Previous Application Made: Yes E] No GjL_ New Construction: Yes,5CNo E] FHA/VA.. Yes Ej No 5c�, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.} Septic T nk: Distance from nearest well---ly-6------Distance from foundation----/D----------Material_ .----------------------------- No. of compartments------0Q,---------------Size--- Liquid depth-------41----------------capacity----L'-A-------- p ?- Length of each line___-___:-_ ---- Dis I Field: Distance from nearest welNumber of iines--- l5__Z)-------D•stance from foundation___---6 j-_-Distance Distance to nearest lot line----_-______ --- Width of trench-----, - V-1---------------- ------- T, pe of filter mat 4'4 - --_____.__Depth of filter material____106__��------Total length--------6-0------------------------- I Seepage it- tante to nearest well____-/6-_()-------Distance, fLom.foundation----- Distance to nearest lot line-------J--------- ----------I ate ber of pits ining material__A4d - ----- ize: Diameter- ----------------- 'st, from nearest well________________Distance fro rfoundation-------------- m ----------------------- Cesspo istance ir -----Lining cut-116 )_77--- El Size: Diameter--------------------------------------Depth----------------------- ------Liquid Capacity--------------------- gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest b0ding----------------------------------------- ElDistance to nearest lot line------------------------------------------------- --------------------------------------------------------------------------------------------- e 0 e n /or rep-,--;ng (describe] - - -------- -- --- ---- ---- ----- ----------- -- -- ----- ----------- ------ - R -d i 4nj 'Y�-- ------ —-------- Ior ---------% ----------- �;• ------:....... ---941 --------------------------- ----------- ------------------------------------- - ---------- - ----- ------------ ------------- --------------- I hereby certify that I have prepared this application and t at the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed' i,&_ . ..... --------------------------- --------------------------------------------------(Owner and/or Contractor) ---------- - ------ By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (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------- ------------------------------------------------ - ----------------------- ------------------- /_IV_-7!1 ---------------------------------------- DATE------- -------------- oi--------------- _61--------- ----------------- -------------------------------------------------------- REVIEWED BY------------------------------------ BUILDINGPERMIT ISSUED------------------------------ ------ ------------------- --—------------ DATE------------------------------------------- ------------------ Alterations and/or recommendations:------------------- --------- -------------------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------ ----------------------------------------- I ------------------------------------- -------------------------------•------------------------------------I------------------- -------------------------------------------- -------------------------------------------- ----------------------------------------------------------------------- •----•-------------------------------------- -------------------•--------------------------------------- -----------------------------------I----- ------------- ------------ ---- -- ------------------------------------------------------------------------------------------------:----------------------------------------- d7— FINAL INSPECTION BY:_X---- - ----- ---------- -------------------- Date----------- ----- - ............................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street �100.:West Oak Street 132 Sycamore, Street 814 North "C" Street Stockton. California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F.P.CO.