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APPLICATION FOR SANITATION PERMIT Permit No. .----- i............_ (Complete in Duplicate) Date Issued -----_7119 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 3compliance with County Ordinance No. 549. �$ �D'?2 Q`�f �l E ' tb-"ria r1�4�`{ 2�(a. JOB ADDRESS AND LOCATION----------/V�0,_'e .. 9` L//V_.,0&:-N------------(-/ ------en-GeAd--------------------------------- Owner's Name---------- -------- Q�} --�^-------------------------------------------- Phone-- Address----------„PT--t------------ ----------7,1,1----•------------------------------------------------------------------------------------------------------------------------------------ Contracto"r's Name-----------------------0-WUl1 G�•------------------------------•------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑ Other ❑ Number of living units: ---f--- Number of bedrooms -------- Number of baths -------- Lot size _____---. Water Supply: Public system ❑ Community system [-I Private [Depth to Water Table _�.s ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam F1 Clay Loam ❑ Clay E] AdoHardpan E]Previous Application Made: Yes E] No QONew Construction: Yes Ll No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND 'SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well--_t_(�------Distance from foundation___:,/47--------Material-----�'b � �_ 4 ____-. No. of compartments---------------------Size------.y_X_x_j_3_tLLiquid depth-------------- --------- _-Capacity....,_6d--O AA 4.. Dispos Field: Distance from nearest well-l_�_U-�__Distance from foundation---/Q-----___.Distance to nearest lot line----LT---i2�• - Number of lines------------�------------------Length of each line_- of trench.-_-______. - __1! _-._-. Type of filter material___,/eat_e___--Depth of filter material____.-1_$`-_e!N____Total length---------- _6"'U----rT'____ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-___-_.___ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------..Depth-------------------•------------ Cesspool: -----------Cess ool: Distance from nearest well-----------------Distance from foundation._- ___.Lining material--------------------_----------------- L1 ___ _❑ Size: Diameter------------------ ------ -----.Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------__________________.___.._-__-_. ❑ Distance to nearest lot kine-------------------------- -------------------------------------• --------- ---------------------------------------------------,--- Remodeling and/or repairing (describe]:__..- . . ” cx M '___ ,� �. +_ = _ �' -------------------------- ~'C ---------------------------;-------------------------------•--•--------------------------------&--------------------------------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------•------------------------------------------------------------ ---------------------------------------•-------------------------------------------------------------------------------------------------•,------------------------------------------------- I ----------------------- ------ - 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)-)<------.. .. -------------------------------------------------------(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 APPLICATIONACCEPTED BY---------------- ---- --------------------------------------•----------------------•-•----------- DATE------------------------- - REVIEWED BY--------------------------------------------- / -5-�--- ----------- ------- ----------------- -- - - - - _ DATE -----••�'-�-�-�--------------....------------------- BUILDING PERMIT ISSUED------------------------- -Q-- _____ DATE--------e I'___.----_ Alterations and/or recommendations--------------- ---------- -- ----------------- - ------------------- ---------------•-- --------------1------ ----------------------------------------------------------------------------------------------------------------- - -------•-------•---------------------- ------------ - .S.4 --,_�s r ca t'r! fit. w-7/_rg"l t�� .t' �A_ f .1----------------------------------------- ---------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------•V------ -----•--------------------------- FINAL INSPECTION BY:.----- ---- / ----------------- Date-----------{ - 7-5 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 Reviseci 1.57 F.P,CO.