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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 County Ordinance No. 549. 4 JOB ADDRESS ND 10CAT10N- ----_- ! �r y� ��c� -- ----- •----- - .-�.°-ver!------------------------------------- Owner's Name---�. bv- . ._ ----------- :.. = -------- - ----------- 01 Address----•----A-E- - rsxi.-_- ----------- - --n----------•------- ---------- -------------------------------------- Contractor's Name, f 4--------- f �� - �. � -�----- -�- -- ------ ------ ----------�-- -----------.- PhoneInstallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other PI r Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------- - ° ---------------:----------------- Wafer Supply:-'Public system ® Community,isystem ❑ Private'[-] "Depth to Water Table------ ft: � r Character of soil to*a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam P .Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: Yes ❑ No X] New Construction: Yes ❑ No FHA/VA Yes ❑ Na❑. TYPE OF INSTALLATION AND SPECIFICATIONS w _ ��; --' •- � .�„ - ,gym=,.��-:-� .:� (No septic tank ar'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_,/_Xd------Distance from foundation___--------------Materi '' --___________ No.of eompartrnents---Z------------- --Sizd _ _^r s` Liquid depth--. -�-- -Capacity e2 _________ Disposal Field: Distance from nearest well /-2-6 ..._Distance from foundation_---? -------------Distance to nearest lot ,® Number of fines----1_ W7Lengfh of each line---W,�'___---____-_-..__.Width of'trench___Ay_" ; l------ -- Type of filter material_lx.% -------Depth of filter material ".............. length--_#1-- --------------- Seepage Pit: Distance to .nearest well-- -_--------------- istance from foundation_-._ 4 ----_--Distance�to`nearest lot line__----- - . p P 1. - 9 -Diameter„ ..: Depth, El umber of Its ---- Linin material________________s--. _ Size. '_.---_-____-_ Cesspool: Distance from nearest well_---=------------Distance from foundation----------'.--.___;:ening material__.---.::.--- ----------- Y Depth ------------- '-----_-Liquid Capacity ------ Privy: stance from nearest well gals ell-----'- --------- --------------------------------Distance from nearest building __ _ ❑ _. Distance to nearest lot-line_- ----------------------- ----------- Remodeling - ----------•--------------------------- -------------------------------------- and/or repairing-(describe):____-:- -=------------ --------------------- J} I �__ •- f , ,.----------------------------------------- , "•- =--------•-�--- ---L s�.._-------•-•------------•-----•---------- ---------------- ---------------------------------------- ------------ ------------------ n k __-_. T I hereby certify-that I have prepared this application and that the work will be done'in accordance w' i �� --- - • --- - --------- - i ordinances, Sf to law , and rules apd regulations of the San Joaquin Local Health District. with San Joaquin County 5i nom_ _ vv ( gYed)_ - - - ---- ---------- ------ ------ _ .� � ......,... 7, ,��,,,_,�,,;..,,�� .{Owner and/or Contractor} By:'-=--..._ ---------------------------- ------ 9 i .P J T (Plot plan, showing size of lot, location of system in relation to wells buildings, efc., can be lac®d on reverse side. FOR DEPARTMENT USE ONLY i - C •'yy l � APPLICATION'ACCEPTED BY__ - --•---- -- -------------------'r • DATE 'J`7 -------------- - - •--------=---------------- -•---- BUILDING PERMIT ISSUED----------- --------------------------------------------- -=------------- DATE l REVIEWED BY -- = - -----------•----------- DATE ----------- i Alterations and/or,recommendations:______-.__._-_ ------------------- --------------------------------------------------- ---------------- ----------------------- ------------- ------------------------------------------------------------------------ j - - i -.----------------------------------------------------------------------- ------ ------------------------ FINAL INSPECTION,. SAN JOAQUIN LOCAL HEALTH DISTRICT 9 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street i Stockton, California Lodi, California Manteca, California Tracy, California ES—<?-2K4 - Rayiseoi 1-57 F.P.co.