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_ APPLICATION FOR SANITATION PERMIT Permit No. �'�"� (Complete in Duplicate) -� ' Date Issued ------/'-/57 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 Ord' ice No. 549. r s, JOB ADDRESS A D LOCATION----- sQUU -_-_._ -------------------------------------------------- Owner's Name-__1_/�,/1j.-9---•----w-p/Z-6�--------•-------------•------------ --- ----- ---------�- PhoneA0---vM31---/---- Address..---------:�`-7 a2------ Contractor's Name---------- �1 /LIl Q- - -- ----------- -----— --------------- Phone----------------------------------- Insfallafion-will serve: Residence [2/ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ i e" Numbe-r of living units: f Number of bedrooms _a--- Number of baths -------- Lot size -- cYz3-- "--""----------------- Water Supply:'Public system 2' Community system ❑ Private ❑ Depth to Water T _f i. 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank of cesspool permitted if public sewer is available within 200 feet.) , Septic ank- Distance from nearest well--��____-Distance rom undation--. P--__.----.Ma jai_--"-� _- ------ " ^ ` --------------- -- `�' _ Liquid depth_...; -, ity- (fid No of compartments-------Z-- Size----_-- --X x -------- ------- -- Dispos field: Distance from nearest well___, ------Distance from foundatio*2 - 1� -. Distance to nearest I t e. -_- - ------7 Number of lines----_---_-1�_�. Length of each line------- _? Width of trench---.� 4- Type Of filter material----.�:,�Q-C. '• 7� � ----_- -�------•--- �• ±� - De th of filter material_-"". Total length --------------. ._.- a Seepage Pit: Distance to nearest well-"--L<9' ______Distance f om f.un ation-----i .........Distanc to nearest Zline--" .---"-_ +� Number,.of pits-------- ------------Lining material Size: Diarn6fer"---+, 17epth- - ------------------------- Cesspool: .- Distance-from nearest well-----------------Distancefrom foundation._.__- ----[_ -,---..Lining material------------------------------------- F-1 Size:, Diameter-------------------------------------Depth-- -------------------------------------- ---- Liquid Capacity-.--------------------------gals. 1 r Privy: Distanceifrom nearest well----------------------------- ----------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-- ------ - --- ------------------------- ----------------------------------------------- ----------------------- -- ------------ ------ Remo'defin§ ----- Remodeiing ad/or—repairing (describe)---. --- -- __'_-_� -t? LC�[ '-' . -- _---_ ------ # , . --- - - ------------ - - - -- - - ---- --- ---------------'---------------------------------------------------------- ---- I hereby certify•fhat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and.rules and re` lations of the San Joaquin Local Health District. (Signed)- ----- ----- A`----- -� ----------- -- --------- - .(Owner and/or Contractor) By-------------------{ -------------- • -------------------------------- ----•--------------------------------------------- -"[Title)-- -------------------------------------------------- ----------- -------------•------------------------------ -- (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 BY - ------------------------------ ----- ----- ----—--_ --- -- '---.`-----^ DATE------ -�- --------------------------------------- BUILDING PERMIT ISSUED-------------- ---- -------------------------------------------------------------------------------- DATE-------- ------------------------- Alterations and/or recommendations--- ---------------------------------------------------------------------------------------------------------------------------___------------------------- �^ ----------- r • ------------------- --- -`` ° ''t'`P ----- ---------- f --•------------ --- 1 f r �i ctt t-a� ------------------------ 67W r FINAL INSPECTION BY----------- --- --- - --- ---------------=--- -------------- Date---- �. -AF, SAN'JOAQUIN.LOCAL..HEALTH DISTRICT .r 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revised 1.57 F,P,CO. ,