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APPLICATION FOR SANITATION PERMIT Permit No. ._ ...... (Complete in Duplicate) _ Date Issued ----- �?.__ Application is hereby made to the SonJoaquinLocal Health District for a permit to construct and install the work herein described. This application ismade in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION...----177U---------- �. v -60 77------- -------------------------- Owner's Name ��.. � 'r --- Phone-4�' � r ._ ta Address �J .... T/ � ---------•-•------=-------------•-•--------•-............. j Contractor's Name------------------ ---- - �� ------- Phone i Installation will serve: Residence Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _:�____ Number of bedrooms Number of baths __— Lot size -------J�V_X---12�________________-___.___ Wafer Supply: Public system Community system El. Private F1Depth to-Water Table 310_ ft.' Character of soil to a depth of 3 feet: Sand ❑ . Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 0- Previous Application Made: Yes ❑ No New Construction: Yes ❑ No) FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: r No septic tank or'cesspool permitted if public sewer is available within'200 feet.) is ank: Distance from nearesr well---------- ------Distance'f om`foundation__.__________.__.__.Material-____.________.__._---_-__.__________________. F31 No of compartments- --- ------- ------------Size---------------•--------•-------Liquid depth---------- ------- -------Capacity-----------•----------- ) Disposal Field: Distance from nearest.well.'A/0-b/C.Distance from foundation__-•�d______.__Distance to nearest lot line_ "'-S._ Number of lines______________�___'.._:___-_-_-_Length of each line---------h ------ --3-----Width of trench---._,Z-r-------------------- filter ��.__.-________ Type of filter material______/ Q ___:Depth of filter material___-: :- ____Total length._ ------�____-_--____k=_______- Seepage Pif: . Distance to nearest well_ -;4V&l-__Distance from foundation___s4-._......Distance to neare'sf'lot line__f----_______ ( Number of pits--r- 1-----------* Lin ing material---- �G ----Size: Diameter-----Sv3........Depth-_-.12-J-71---------------- cesspool: Distance from nearest well_ ..............Distance from foundation-------------_--- Lining material_____._.._____-____.__-_-_-_________. ❑ Size: Diameter-e- - -------k-------- Depth----------------j-------------------- 1_' --._Liquid Capacity----------------------------gals. r r,. Priv Distance from nearest well_____________ ------------.._____------___Distance fro nearest building- ---- ❑ Distance to nearest,lot linea:_____ .___ - ---------------------------------------------------- r " Remodeling and/or ra airin (describe]:_______ .__ _ __ _ ______ _�_ _______-1�a-1 ------ -57--- . --- • ----�--- - - - ---- ----- ---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby:cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and les and regulat' of the San Joaquin Local Health District. t i (Signed)9 ) c am -----------------(Owner and/or Contractor) o By: = _ ----------------------------(Title)------ ------------------- I (Plot plan, showing size of lot, location`of sys em in relation to wells, uildings; etc., can be placed on reverse side). + FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------- --------------------------- --------------------------------------- DATE-----,--- -�--- -- ----- ------------------------- REVIEWED BY-----------`----------------- - =----------------------------------- DATE---•--------•---------•------------------------------------- -- -------------------------------------------- --- BUILDING PERMIT ISSUED---------------------------------------------------------- -----------------=---=---------------------- DATE--------------------------------- Alterations and/or recommendations: __._ __ .___ ________ _ _____________ a------------x _----� Y 1. r y,e� 5 "'___ _ __ ----------------- _F, �) _____ {,�,j]---------------•----------- t- ----�-- -�- ---- �r+'I�-_.1__--- ----_ -I��'� - ---_._F__ _ ___ _ _ _______ __VV__ _�•4___r___________------------------------------- ----------- Z44 _._-_-_____ _ - - __S_______-- ___ r _____________________________ �+�& -- ---- --- ------- ----•-- ......-�1._ - ---•---•-----•------------------------------- - FINAL -INSPECTION BY:A- 4-----•-------------=------------=---------- - w Date--- •� SAN JOAQUIN 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 F.P,CO.