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APPLICATION FOR SANITATION PERMIT Permit No. ---7 (Complete in Duplicate) Date Issued --- 2- 7 Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 6 ej JO->- A- B ADDRESS AND LOCYAT:91 �1..'R7 ------/e/,_0---)d-.----..4r m�;�w-------- ---------------------•------------------- .. Owner's Name------------- 04.R_ Address-.----------JF7....../----------_13,oY------------7_/,__0--------------------------------------------------------------------- Contractor's Name-------------------------- N R 0----------------------------------------------------------------------------- Phone-------------------------------- Installation will serve: Residence M---Apartment House [] Commercial [] Trailer Court [] Motel [] Ofh6r 0 Number of living units: __/--- Number of bedrooms ._,4,_—_ Number of baths __/--- Lot size .__ ._1�'_ ___—------!?q-,2-------------------- Water Supply: Public system El Community system E] Private [Depth to Wafer TaUe ft. Character of soil to a depth of 3 feet: Sand F-1--Gravel [] Sandy Loam El Clay Loam [R'.Clay E] Adobe E] Hardpan C] I Previous Application_Made: Yes [] No R- New Construction: Yes lil��OEI FHA/VA; Yeso No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest Distance from founcla�ion-----/10. Maferia1_a,/VC....... ------------- - No. of compartments-----------2,---------- ILLiquid dep.th-------- ----------Capacity---- 7__� Disposal ield: Distance from nearest well----b/___.._Distance from foundation-----/0---------Distance to nearest lot line_%ml IT Number of lines_-________ __-- ----------Length of each line__________C.......-. - ------Width of trench____________ _ ----------- Type of filter ma' of filter material__;.__/_it---------Total length--------------- --------------- See it: Distance to nearest well--______40.0-Distance 40-0-Distance f� foundation---- -------Distancp, to nearest lot line_____---- -------- Number of pits----/z------------Lining maferiaI____/<0_C_4t_Size: Diarnefer._,3_2........Dept h........c�_%6'? ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__----_________.___-._-------_______ Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity... ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.-_---_---- ❑ - Distance to nearest lot lire-------------------------------------------------------------------------- Remodeling and/or repairing (describe):------ ------- ---------—-------41�_ ---------- 7----- ------------------------ 00 _V - ------------------- ------------------------ ---------------------- --------------------------------------------- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).A,v�e�or,-_ ------------------- --------------------------------------------------------------------(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---------------------- ---------------------------------------------------11------------ DATE---------------------------- REVIEWEDBY_-------------------------- --------------------- -- -------------- -------------------------------------------------------- DATE--------V1-" Isg :�_ ----------------------------------- BUILDINGPERMIT ISSUED_______________________ - ---- ----------------------------------------------------- DATE---------- - ------- - ----------------------- ------------ Alterations and/or recomrpendations:----------------- - ---------------------- ---------;;;!- --------- ---------- ----------------------------- .....r ---------t�----------------------- AT------------ - --------------------------- ----------- --- 01- -- -------------- - -- - --- ----------------------------------------------------------------------------------------------------------------------- -------- CAL- 7- -------------- --------------------------------- ------------------------ ------------------------------------------------------------------- ------ ------------------------------------- ---------- 7------ FINAL INSPECTION BY:-------'-- ----y-------------------------------------- Date--- ----------- 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-9-2M Revisea 1-57 F.P.CO.