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APPLICATION FOR SANITATION PERMIT.'.' Permit No.`.l_Q__•`KJ40/_ 9r (Complete in Duplicate) Date Issued 9 f gp€ication is hereby made to the San Joaquin Local Health District for a permit to construct and instal€the work herein described. This, application is made in compliance with County Ordinance No. 549. , JOB ADDRESS AND LOCATION-___ r!_-__�--- -- - -------2 6 )126'1S�/20 'i`.7/y y:725 c 3rd S � ------� ----------- ------ --------------------- Owner's Name----------------------(�_,!!'--,--- --------------------------:------ ----------------- ------------- Phone-- Address----- --- ; -----------=--------------- � -------`3- ----------- S + Contractor's Name-------------------3_A?vh------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . �„ rte.) (:44 Nuniber'of living units: __ __ Number of bedrooms _Z___ Number of baths>_]____ Lot size _------- _--!'#___-__ -+ ___� Wafer Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ________ ft. Character.gf soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B-'Hardpan ❑ Previous Application Made: Yes ❑ No ET-1,New Construction: Yes [5-lNo ❑ FHA/VA: Yes ❑ No D� TYPE OF INSTALLATION AND SPECIFICATIONS: y; (No septic'tank or'cesspool permitted if public sewer is available within 200 feet.) ! I tI Septic Tank: ` Distance from nearest well_7)-t ?-__Distance from foundation__.f{1_._____:-_-.Material____-_ _______________ _______________________ I" No. of-compartments---_Z ----------------Size-_A _7�_.y----:---Liquid depth__.__2_�-.----------------Capacity....ROD---------- Disposal Field: Distance from nearest well_?v _Distance .,from -- f_oundation----!P-----------Distance to nearest J lot li`ne_.�J________ iNumber of lines=__.____�__- - --;� - Len Length-of Wdth of#tench:-----� (.--------------------- X Type of:flter materiaL___Y----------Depth of-filter-material____. --------Total length_________- Seepage Pit: Distance to nearest well'--------------------Distance from foundation---------------------Distance to nearest lot line__.______._____._ 0 Number of pits---------- ---------Lining material--=-----'------------Size: Diameter---------------------- Depth--------------------_------------ s Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- _j ❑ Size: Diameter--------------------------------------Depth-- --------------------•---------------------------Liquid Capacity----------------------------gals. J --------------Distance from nearest buildin Privy: Distance from nearest well------------ - ---_______.___'-=- buiidinq------------------------------------------ ❑ Distance to nearest lot line_'--------_`"____ '.___--'_ i Remodeling and repairing (deserilee):__,_---------------'--_=-- �' .-_--------------------- ----- -------------- 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 re ulations of*theSan Jaqui opal Health District. 5ined( 9 ----- � � -- -----------------------------------:-----=----------------{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----- -�-r}"y - - `,.-„- -- ------------- DATE----- 3----------•---•------_----- - � - - - - -- REVIEWED BY-------------------------------- ------- ------ ----- ---- -- ---------- --------------------------------- ------------------=--=-------- ---------- DATE----------- - -----------------•---•----- •> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------- - ------------- Alterations and/or recommendations------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- •------------------------------------------------------------------------------------------------------•---------------------------------------------------------- FINAL INSPECTION BY:---- l/ Date---. - 2 1 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 E5-9-21VI Revised 1-57 F.RCO. 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