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APPLICATION FOR SANITATION PERMIT Permit No. _.I41 3 ' ______ pDuplicate) (Complete in Dulicat ) _ Date Issued .2_0 g z-?V-3 2- 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. w � ' JOB ADDRESS AND OCA710N....__ -: _.._ _ C' e--- ----------- ------ �1, --- -- Owner's Name ------ ne-------- Address--------------�-/-----��------ 1 l p I ------------- - -----------------------------------------•--- Phone Name Phone.. Installation will serve: Residence��m n o pa e t H use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ iIN� Number of jiving units: -c.]--- Number of bedrooms ---�.. Number of baths . ._ Lot size -------- ----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _6___ ft. �I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No$f New Construction: Yes E] No FHA/VA-. Yes E] No j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ► Distance from nearest w6lCIV -----------------Distance from foundation_--._-_---.---_-.-.Material---._..-.-------------------.----_._-,•_.._...--.. No. of compartments -Si e..ri ____-----------.-_...__-_Liquid.de th---distance to nearest lot li --- P ------- P. Capacity---- tPos,11 Field: Distance from nearest well lQp-. to ce from foundation � I t � _ Number of lines------------- ___-..._--- ength of each line....___�.. ��ii------ .Widt4� of trench..__._�,�' - I...-�_ Type of filter material-.._,S__ __ epth of filter material---------J-.L�_------Total length_---/ �Q--------------!I----.------ eepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot fine----_-I--------._ ❑ Number of pits----- -Lining material-----------------------Size: Diameter-----------------------Depth......................1----------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- --...Lining material-------------------------------------- ❑El Diameter--------------------------------------De th----------------------------------------------- gals. P - Liquid Capacity-----------------------�---- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_.__....___________--_-._...!-----...... ill ❑ Distance to nearest lot line----------------------------------------------- ----------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------- I - -- i ,i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St+ate�I ws, and rules and egulations f the San Joaquin Local Health District. I ! 'Ct r M I {Signed)-Y- ----- .r'!!I�C+'1rlL_----- -G�Z' ,f - -/r -- - - -�-----------------------------------------------------------------(Owner and/or Contractor) i By: -------------- Title r (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- --- --- ----- ---� ---------------- DATE--- ---------------j REVIEWED BY_... ------------------------------ DATE -/ '•Y ter` BUILDING PERMIT ISSUED---------------------- ---------- ---------- ---- DATE ------------------- /. -------------- Alterations C -Alterations and/or recommendjf�io, ---------------- ------------------- ------------------- --------- -_.-- ............._.__.•-----.....---•----........_-•-- ._.r r r s -- - --- ------- - - - ---------- ---------------------------------------------------------------- --------- ---- ----------------------------------------------- ----- -----------------------------------•-------------------•-------------- -------- -- ---------------------------• --------- ----------------------------------------- - ----- -----------------------•------- ---- ----- ------------------------------------------------------------------ FINAL INSPECTION BY--------------------------------------------- ---------'/'`_ est)ate-------------------------------------- --•--------------------------I;------•---- SAN JOAQUIN LOE T (STRICT 130 South American Street 300 West Oak Street Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9=-2M , Revised 1.57 F.P.CO. i 4 r