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APPLICATION FOR SANITATION PERMIT'S F; Permit No. ..22.j._ 9. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date. Issued --- /v �_I,/ 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 —--------------------------------------------� �- { Owner's Name1 -------------- . . -- -- _ - ------ ---_ -' = ------'-'-•-. Phone.------=-------------------•--..... Address ` Zv7 l � i� ------------ --- . _ a = -----•----------------- Contractor's Name-----'--- -------- { • � ...... -----. Pho 'Installation will serve: °Residence Cy Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel E] Other ❑ Number of living units: -, _ Number of bedrooms -.Z--- Number-of baths _-, - Lot size ---------''_�` Z _"--____________-_ Water Supply: Public""system Community system ❑ Private ❑,~ Depth to Water Table --- ft. ' f i Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe _ Hardpan ❑ Previous Application Made: Yes ❑i No 5< New Construction: Yes,10 No ❑ F FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: I { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest 'well----- from foundation......--_G------Material-- ,�r1;-1_rI'-,./Nr _ No. of compartments-- -----�----------- iSize- _ =Liquid depth V -------Capacity- -_?A� � i Disposal Field: Distance from nearest well....--"�____iDistance from foundation-----1.�---.--.Distance to nearest lot line---- ---------- yp -- -----'Length of each line-----------9�--- .....Width of trench----- Type ----•--"-- ,.-----'----'--'---- Number of lines--------------/:_-__-- 1 R y Depth of filter_materiaL_ __ =-.wTotal length____----- `-------------- 7 e of filter material---- e-- Seepage Pit: Distance to nearest,.well.-------_ - Distance from foundation-----/ .`._-"D,istance to nearest lot line----/O_--._ r F Lining material-- .! E Size: biometer -, _. -.Depth------1.0-- --------- � , Cesspool: Distance from nearest Number of P �. p �'_-------Distance from foundation--------------------Lining materiel-------------------------------------- --------------------- --____----_-___..----._____._-_-. ❑ Size: Diameter = ' Depth- --•-- ----Liquid Capacity..-. . - gals. . Privy: Distance from nearest :well_-`----------------------------------------------Distance .from nearest buildin ❑ Distance to nearest lot line.---- ------------------------- --------------------- ---------------- 7 Remodeling and/or'repairing (describe)=--------------------------------•--------------- -------------------------------- -------------------------------------------------------------------•--------------------------------------•-------------------------------------------------------------------------------------------------------------- ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------ I hereby certify that I have prepared this application.and that +he 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)------------------------' -'� `' ;' y- ca �' ' ' ------------ Her an Factor) By:------------------ � - ------------------(Title)------ ----------- ---F------------------ - -------------- (Plot plan, showing size of lot ocation of s em in rely ion to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY_ - ------------------------------------------- DATE------ �- -/07 .-.Y.G. REVIEWED BY---------------------------- ; DATE ---- ---------------------------------------------------------------- --- ------------------------------------------------------ BtJILDING PERMIT-ISSUED ----- - -------------------------------•------------------------'------------------- DA•TE ----------'----'--------------- Alterations and/or recommendations:----- -, x — - - - �- - -- .-_ - --------------- ------------- ---------------------- -•--------------------------•---- ---- -- -- -------- ----------------------—---------- —�- n— h tir Q �`---- --- -- ----- -------------------------------------------------------------- FINAL INSPECTION BY=---- --------f----•---- -------------'----------------------- Date-'--'J- -- � . ' SAN JOAQUIN LOCAL HEALTH DISTRI T 130 South American Street 300 West Oak Street 132 Sycamore Streot 814 North "C" Street Stockton, California ? Lodi, California Manteca, California Tracy, California FS-9-2M Revised 0.'59 F.P.Co.