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APPLICATION ION FOR SANITATION PERMIT Permit No. -_l_0- �- �:_: �} :� 1 (Complete in Duplicate Date Issued r//�S� Application is hereby made to the San Joaquin Local Health District for a ermit to construct and install the work herein descfibed. TI1isfapplication is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOrQATIO --------- --- ---- -- / ___ __ ______________ _____ 1---Owner's Name_____-- - -- -_ - .--- - ----- -- ' '- --- -- Phe--,( Address Phone fY' _ l It Contractor's Name -------------------------- �F - ---- --�-------•--- Phone - --- ------- Installation will serve: Residence Apartment House ❑ Co ercial i ❑ Trailer Court p Motel Other s Number of living units: _/__ Number of bedrooms - Number of baths Lot size' Water Supply: Public system CammuriitY s stem ❑ Private ❑ Depth to Water O Op TabI4/44ft, Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Prbvious Application Made: Yes ❑ No New Construction: Yes No ❑ Clay ❑ Adobe ' Hardpan ❑ 9 u ti ❑ FHA/VA3 Yes ❑ No a TYPE OF INSTALLATION. AND SPECIFICATIONS: i (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestDista wel 1 nce from foun ti n__ _gip -----,Mat No. of tom artments_ _ Size_ p � �---------------- ----- uid depth-- isposai Field: Distance from nearest well 'from Capacity___--- d_ l Distance foundatio ' t` Number of lines------ [ istance fo' nearest lot line____,. ---------_ L--Length of each line-__ - ------ ..Width of french _' Type of filter material- -----Depth of filter material-----.,h',�`____'Total length-------------�4'--- ---•-----SeepagePit-Pit; Distance to nearest well_ ,.- -d" __ Distance from,f ndation ______ Distance to nearest lot line.___-,r _�__ Number of its4 p --------------Lining material _ _ ___-- --size: Dj eter__.�,�-----------.Depth------ ___'_____________ Cesspool: Distance from nearest well---- _-____.._ Diltance from founds ion_____-____ rDiameter - 3 ___-.-_--.Lining material---------------. -------------------- .Size: r---- ------ �------- ------ Depth------------------------------------------ Liquid CapacitY -------------------------gals. Privy: Distance from nearest well__.. -____._-_-.____t R — -f—one ._ ________________________Distance from nearest building 9-=--------------------- Distance to nearest lot lire----------------------------- -- Remodeling and repairing (describe):__ -- ------------ ---------- . -t_ _.. - -------------------------------- ----------------•----<_1 ----- .z------- --- - ---- - -.----TkEN �__-----5p� : - ------- -- --- - 1 -- - ere y certify that I have prepared this appli ation an that the work will be done in accordance with San Joaquin County ordinances, State laws. and ru s d regul ions the Sa oaquin Local Health District. (Signed)- _-- - -- -_____-(Owner and/or Contractor) � -(Title Pof plan, showing size of o o at, n of em in relation to wells, buildings, etc., can be placed on ever side). FOR DEPARTMENT USE ONLY f I APPLICATION ACCEPTED BY____-____--j^-t�-.- 7 . � - Za --------------------------------- --------------- REVIEWED BY ' DATE. --------- ---- BUILDING -BUILDING PERMIT ISSUED---------------- f' ZA ----------- ---------------------------------------------------------- DATE----------------- •----------------------- ----------------------••-- --------- ------------------------ DATE. Alterations and/or recommendations: �_ `�Q�? � Ppm - TF-PA. ..... � O D�_! G------ -----p p #�-- S�Ti'c_--'T_It.NY�----1 f�t��A1.1��----�•�___-T'---.cs-'- ---------- - ------------------------------ -----`---- ------------r----- - - ---- ----------------------------------------------------------------------------------------- ------------- ---------/-------- -- FINAL INSPECTION-BY-:--_.1 --- -------- ----- Date---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" 5freet Lodi, California Manteca, California Tracy, California ES-9-2M . Revisea 1-57 F_P.CO.