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t1Z 3e� APPLICATION FOR SANITATION PERMIT Permit No. (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 Count Ordinance No. 549. JOB ADDRESS )ND LOCA ION --- . -_ d - ,iv • _y Owner's Name__�.J1�-�� - .� � :; - -•----------•---- ----. - -•---••---- ___ Address-----------------��- ----------- _. -------• ______�_L.K.+ _____ + Contractor's Name_ i -- � -------- --�-i------- - - ---------•--------------- - - Phone.- ----- ---.l'�-- Installation will serve: c Residence E r ' = ' Apartment House ❑ Commercial '❑ Trailer Court �❑ Motel ❑ Other ❑ ' Number of living units: ----____ Number of bedrooms _-______ Number of baths"__:--___ Lot size ____�•% € __- _ Water Supply ''Public.,system ❑ Community system ❑ Private ❑`DepfhtoA Water Table �-�ft:, �.. Character of soil to aldepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay „ Previous.Application Made: Yes [] No ❑ New Construction: Yes No ❑ Adobe❑ Hardpan ❑ _ ❑ 0 FHA/VA: Yes ❑ No ❑ TYPE:OF INSTALLATION AND SPECIFICATIONS: {No septic tank or°cesspool permitted if public sewer is available within 200�feet. , p rr4 � ; .. . xF. . Septic Tank: Distance from nearest welL�!__--_:_____Distance from foundation__ __ Ma rea)____ _ f ` t No. of'compartments_ `Size r� �/ f r ` Liquid depth---- Dis osal Field: I - : � - rr � --- 'Capacity,, " )Distance from n r st w ll_ t`ADistance rom foundatro __:_-4 _._-Distance to neares# lot line_ __4 ------- Disposal of lines :' _4 ----_F Length of each line -----_------Width of trench._ Type of filter meterial__/ rc .__'.Depfih of filfier material_ _ « Total length---..-_�Lr L Seepage Pit: Distance to nearest well �< -�pistanc rorrj founcletion=_ __ - .'Nr _, '____.:.Distance to nearest lot umber of pits-=-- - -_'-`--Lining materi ------ Size:-Diameter--- fl---- i Cesspool: Distance from nearest well----' :.________ Distance fr foundation.__________________.Lining material------------------------ ❑ Size: Diameter----------------------- Depth ---- Liquid Capacity gals. Privy: Distance from nearest well---------------------------------- t ❑` Disfance•to•neare'st lot line_---•^-�__"____.__-_._ � istance from nearest building-'________________________________________ rr � -- -- - .. Remodeling and/or repairing {describe�:_�' -- cw- t_,- 4 4- ________________________ -__._ ------------------------------ --------------------------------------------------------- r ----------- ------------ -------------------------- -------------- ------------------------------------------I------- ------------------------------------- -------------------- ------------------------ -------------------------- __________________________________ . -------------- ------------------:---------- __---------------------------------------______________________________-----------------------------------------------------------------------------.. -__.._-_-- I hereby certify that;l have aPe application and that the work will-be done in accordance with San Joaquin County ordinances, Sf4te I s, and rulesons of the San Joaquin Local Health"District. Si ned g ------- 1-�4---- -- 6 1, y '---------:--------- ------------- --�----. ----------------------- By: - ------�Ov+�r►e*--arrdfeF-�ontractorJ 4 ' Plot plan, showin -------------------- -------------------s, ------------- ---------------- =-- ------- =-= (Title)--- -------------------- g size of lot,.location of system in relat ion to wells; buildings, etc., can be placed on reverse side]. • FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY__i __ __',_._ L ATE-1 -------------------------------------- D REVIEWED BY -� ------ DATE_- ---•------------ BUlLD1NG PERMIT ISSUED - ---------------------- (n DATE -- - Alterations and/or recommendation ._ - �z @ -. ------•---------------- iC; -------- ----------- ----- -------------------•---------------- --------- - t--------•f l _ ---- > - 1 ----_- ------------- ---- - x - ____________ P .___ i __ -_________.-_____._____.______-___.-_____________ ---------------- ----------- ------ _ .-__._____.____ ____________ ! _ jam/ „ Y ---- r FINAL--INSPECTION BY:_- -- -- -- - -- -- -- --------------- '---'"-=----- Date- JO ate_ ' JOAQLIIN LOCAL HEALTH DIS ICT 130 South American Street 30D es+ Oak Scree+ 132 Sycamore Street „ 814 North "C” S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California E5 -9-2M Revises 1,57 F.P,CO. -