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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ; p 1 Date Issued .�' (.� I on is hereb made to the San J aq in docaAealth District for a permit to construct and install the work herein described. s Applicata Y This application is made in compliance with County Ordinance o. 549. + JOB ADDRESS AND LOCATION-_ _ _ " U4- Ay�1 ----(-- -- -- -------- ---•----- ; Owner's Name_______ -------------------------- Address---------- -----•------ - /� • Phone--------•----------------- ------- Contractor's Name__.______-__F;`lv_c• - Installation will serve: Residence House,❑ Commercial ❑ Trailer Court ElMotel ❑ Other /40 �ao 0 �__ Lot size - ------ ---------------- -_ Number of bathv-A- Number of living units: :(-."" Number of bedrooms j Water Supply: Public system ❑ Community system ❑ Private-[�epth to Water Table —7..4-- ft. ❑ y �C y ❑- Ad Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam -7..4- Clay Loam la Adobes Application Made: Yes ❑ No 9/'New Construction: Yes �o ❑ FHA/VA: Yes ❑ N i Previous pp j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per if pu lac sewer is available within 200 feet.) 9 Septic Tank: Distance from nearest wef _�,� --Distance from. foundation___��`"."----.Materialt___ ___�:.- p _Ca aur -di - Liquid depth---�_�- ------ - p Y----- No. of compartments____ ________________ " i 10 00, __'_Distance from foundation__---------Distance to nearest of line--24P --.-- Disposal Field: Distance from nearest yJell.- l�' _ Length of each line______ s -----------------Width of trench____ -- r� W j , / Number of lines-------- _______________ gi Type of filter material __4 - ----Depth of filter material__-.j -f---Total length________ _e """"---------- #V �� O_ Dista ce to nearest lot lineti _____________ Pit: D+stance to nearest well___ -"-----Distance from fou ation___.¢ i� De th___.-.P? ---------------------- Seepage Number of pits___.l._-____- _____Lining material��. 5¢e: Diameter___ __ p ing t Cesspool: Distance from nearest well_________._____-Distance from foundation------------- Liquid uid Ca p material gals. -- --------- ---- - ---- ❑ Size: Diameter------ --------------------------- Depth th ,_._Distance fro-m nearest building--------------------------------------- Privy: Distance from nearest well--------------------------------------------- ❑ Distance to nearest lot line________________________________ .----------------------------------------------------- ------------------------------------------------- Remodeling and/or repairing describe :_________-_ - - ---- -------------------- -------------------------------------------------------------------- x I hereby certify that I have rules a andred this ns Ili the San Joaquin hL caf Heal#heDi trlc#n accordance with San Joaquin County ordinances, State laws, - -� �--- (Owner and/or Contractor) __(O d/o -------- (Signed) , l y 9 SY:--------------""-""""""-'""•'""""---`"' buildings,s, etc., can be place on reversAide). �- (Plot plan, showing size of lot, Iota n of system in relation to wells, FOR DEPARTMENT USE ONLY _ DATE-------- ----------------------------------------------- APPLICATION ACCEPTED BY_------------------------ - - DATE--- - -�---•-� ------------------------- •-------- REVIEWED BY-------------------------------------------------- I_ DATE---------- BUILDING PERMIT ISSUED-------------------------------- ' C�{.e�T - -------- Alterations and/or recommend ions:___ _-_""-- --------------- -- -------------- --- ------ � - -- -- — -- ----- ---- ------- Dale------`- - — � �---------------------------------- FINAL INSPECTION' BY:_____ i a4-�------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 Wes} Oak Street y Tracy. California Stockton, California Lodi, California Manteca, California y. �' L5-9-2 M . Revised 1•57 F.P,CO-