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APPLICATION FOR SANITATION PERMIT / Permit No. (Complete in Duplicate) Date Issued _f //S"7• Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th�ivork herdescribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONS .—�- _0—Owner's Name_ /�" >� Address"------------------- --��__.."A,)-I- ---------------------------------- one c -----"------------------------- ------ -•----------------------- 5:_ --- - - Contractor's' Name «- '�---F� 1- i - L ------- ----------------------------------- Phone..-�-7-Q"`�___� Installation will serve: Residence'�Apartment House ❑ Commercial [] Trailer Court t Number of living units: Number of bedrooms ❑ Motel ❑ Other ❑ a�G�-. Number of baths -_,��size _--_---__-�'Q_', Water Supply: Public system y ---•-------- --- �,.- y ❑ Community system ❑ Private.�th to Water Table ft: Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes i No �-� ,. ❑ New Construction: Yes E ivo7❑ FHA/VA: Yes,�No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if ublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ _- =Distance—from- __-0" No. of compartments_.__ -- f aterial--- -------------------A --------- SizeSG Et'� p :" Li cuid de th__ ep�! Capacity ;G4 Disposal Field: Distance from nearest wel --- tix 3 `` p ---- •--- `� --__Distance from foundation-"" _ i -----""."-Distance to nearest lot line"_ -_______ ��~ Number of lines---._----- Length of each fine �?--------------- Width of trench-AY-11-11 Type of filter material-__"- Depth of filter material---1___!!__-_-_-_ e Number t its---- Total length-------- Q " (� Seepage it: Distance to nearest well -__- _` "' " oundation___ ` Q -//fQ____D.istance to nearest loft line/------- --- i� �s Lining materiialC- - o-- f - Size: Diameter"- Depth r 2 --------- Cesspool: Distance from nearest well _ _____Distance from foundation ""_____--.Lining material-"- "_.._---_.__-_•_____ r ❑ Size: Diameter.-- - --- --- : ----"---Depth-------------------------------- q p Y -------- - gals. " ""___-"Li Liquid Capacity_--------" f ivy: Distance from nearest well "-_Distance from. nearest building J ❑ Distance to nearest lot line-"------- -------- i. ---------------"----------------.. - - -: ------------------ Remodeling and/or repairing (describe):---""_- _--_-----"--___ - ---------- I -____------- ----------- --_-_--__-_____-------_-____ - 1 --'-_- --.r.------ -..----------------------- ------ ------------------------------- -"-_-- ------ -------------------•-------------------------------------------------------------•----------------`---------------`----------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, rules and regulations of the San.Joaquin Local He h District. { (Si ned Z-f ' Q 5_ B . -- ------ ---------- ` :: ----VQ_ c.-.-- -�_ ---- � _�--------- Y• - Contract ---------------------- -ON,, -- ----- - - ------ ------(Title-- ` _ _ _ Or�(Plot plan, showing size of lot, location of system in relation to buildings, etc', can be placed on reverse side). -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------t__ REVIEWED BY r ------------------------------- DATE--------------------------- d � ---- BUILDING PERMIT ISSUED------------ - -- -----r-- ------------ ----------- DATE -•------- ----------- Alterations and/ r recommendations: A ---------------------- ....................................ll� '� ----------------- --------------• -- --- -------------------------------------------------------- ` r's; - -- ------------------------------------------------------- r ---------------------------------- -------- ----------- -- ------------------------- - ---------------------------------- - ----- ---i FINAL INSPECTIOAe�4. :- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT. Stockton, California 130 South American Street _ /} 300 WI Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California -� Tracy, California ES-9-2M , - Revised 1•57 F.P,CO.