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li r APPLICATION FOR SANITATION PERMIT Permit No. .' _7-3._ ' (Complete in Duplicate) � :/ Date Issued -----_.___ _._. 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. JOBADDRESS AN LOCATIO _ hy// _________ _„ � tsa---------------------------------------------------------------------------------------------------- _-_- Owner's Name_____L --.-- ---------------------------------------------------- Phone----------- ------ Address-------------- _--_-_ -- -- ---------------- / -----------------------------•----------------------------------------- Contractor's Name-- '-... -- -- ---------- { -=-- ----)------------------------------------------------------------ Phone------------------------------- --- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Mptel [❑ Othpr ❑ I: Number of living units: _ ____ er of bedrooms _ Number of baths,;--n----- Lot size _ _ l -- ----------------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth'to Water Table -------- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ T*PE OF INSTALLATION AND SPECIFICATION$.— ', +”" (No septic-#ank or'cesspool permitted if p blit sewer available within 200 f e#.} Septic T Distance from nearest well_!!! Distan e�from�found tion__ _ t_ __ Mate r'al--- ___________________________________________ �! No. of compartments_._______ ize c._ ,3__� ____Liquid depth___ !_______________Capacity_____gd�_ r 4 F t Disposarh,Ol e d: W Di-stanCe from nearest well:_ r _._.Distance from foundation__ __ __________Dir nce to nearest lot l �__ _-_- Number of line�--------2-------------- '---_Length of each line _ ____ _. idth of trench__„ _ ? �l Type of filter material ______ __._ Depth of filtor,,material_____ _�Y____Total length__- l_ 1 Seep�e Pit: Distance to'nearest wel7t_4c_______ Dltanc soundatlon___1_D___r_ _ ..Distanr�e to nearest lot line-__________ ' Number of pits------/------- Lining mat'ria l--,l�___-- _-_.Size: Diameter-----s3_A----____--Dept h-------�5_________________ Cesspool: Distance from nearest wail_________________ Distance m foundation___________________.Lining material------------------------------------- ❑ Size: Diameter---------------------_:---------------Depth--------------------------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building.___________________._______________._. ❑ Distance fa.-nearest lot. line ----------------------------- ---------------------------• --------------------------------------------------------------------- Remodeling and/19-1-1,repairing..(d scribs3) - -------- -------- ------------------•-----------_------•-------------- a -- p --------------•- --- �^-k `_...... -IL---------_ ---------- --- ------------------------------------------- ------ ------- -------------- -------- ------------ ---------------------------------------------------- -------L----------- --- --------------------------------------- -------------------------------•---------------•-----------------•-------------------------------------------------------------------------------------------------------------- � I'he.�eby certify that I have prepared this application and tha# the work will be done in accordance with San Joaquin County ordinances;.-St ate lows, and rules and regulations of the San Joaquin Local Health District. f[ 15i ned } ----- -------- -------- - (Owner and/or Contractor) gy:------- -- - -�?-------R1a_Q_TEK------ - 0 =r -----------(rfle}--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in .relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY------------------------------- ----------- ------------------------------------------------- DATE-------------------------- ------------- REVIEWED -----------REVIEWED BY------------------------------------ ------------- - ------ - - ------------- ------------------------------------ DATE--------- -------------- BUILDING PERMIT ISSUED----------------------_-- ----- DATE ------------------------------- Alterations and/or recommendations:----- ---- ----- -------------------•----------- ---------------------- ^�`------I-- ------------------------------- ---------- - --------------------------- --------- - ------- ------ ------------------------------------------- > -- --- t �> i` - -------------------------------------------- ---------------------------------------------------- - -- -------------- FINAL INSPECTION� :..__ _ Date__ 29xi 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--9-211 , Revised 1-57 F.P.CO.