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APPLICATION FOR SANITATION PERMIT Permit No. .__ f T-- -.--- (Complete in Duplicate) Date Issued .__��'�_VA7 Application is hereby made to the San Joaquin Local Health District for a pew to construct and t he work h�erei�es described. This a licafiori is made in compliance-wit, -ou ;y-Ordinance No. 549. s6f-�'"`'� �Q _ �� �. oun rjW JOB ADDRESS AND LO ATION - ._-. —._. aj -------------------- e_ --- of xk, � ... ------ Phone_ :------9 �, 0 Owner's Name--- ----- -- -- -- -- ----- -------r•-- --------- Address--------------14 11 nn Contractor's Nam _._ a"''1 -- ------- = --- ` 4 Installation will serve: Residence Apartment House ❑ - Commercial ❑ Trailer Court ❑ 0___ ❑ Other ❑ --++��._-- Number of baths t' Lot size _--•-- ------• ------------- Nurrsber of living units: _�____ Number of bedrooms]Water Supply: Public system [3 Community system ❑ Private J2-15epth to.Wafer Table --`,7 ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes �o ❑ FHA/VA: Yes ❑ No D�_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 24d feet.} ' /O Mat r-al -- ---- Septic/Tank: Distance from nearest well-7 -..--Distance from bun dation!----------- ---- Siz _ .. Li uid de th--- - --- -----------Capacity__f. ------- No. of compartments--Z eX q p © F --f_.Di ante tom foundation--_ _.______-_.Distance to nearest lot line----------------• Disposal Field: Distance from nearest well- A �Z�e s1 0� Number of lines__-. _-- Length of each line�m---- Q_'--- --.Wkdth of french----=--------------- ` ---- Type of filter materia �--- ----Depth of filter material_-- -rr.._.-_..Total length _'__________-.----_•___-- i Seepage Pit: Distance to nearest well----------------------Distance from foundation Distance to nearest lot line---------------- ❑ ___.___-______----- - Dept --------- ----------------------- Number of pits----------------------Lining material--------_------- -----Size: Diameter Cesspoo4: Distance from nearest well-----------------Distance from foundation--------------------Lining material---..-.----__:-__------------- als. El Size: Diameter. Privy: Distance from nearest ------------Depth---------------------------------- -----------------Liquid Capacity----------------------------g tiwell._._________..- ___-- - _ ----- -_______________Distance from nearest buildin 1 . - l ❑ Distance to nearest lot line----------------------- ------------------------------------------------ ---------------- ----- -------------------------- ---------------------- ------•----------------------------- -------------------------- Remodeling and/or repairing (describe)-------------- ---•-------------•--------------.-----------•------------------------------ ------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rules a regulations of the San Joaquin Local Health District. t l__r: ........... [Signed _ � --------------------------------------- ---------- - -- ---- - Contractor} /e11,t %J --- -----------{Title}--�.J ------ ------------------------------ -- ------- - --- (Plot plan, showing size of lot, location of ys+em in relation t wells, building p s, etc., can be laced on reverse si a). FOR DEPARTMENT USE ONLY DATE--------- . / ��,--------------- APPLICATION ACCEPTED BY -_____._.__---_. ` y�1 -------- - DATE------------------------------------------------------ REVIEWEDBY------------------ ------------- - ----------• ----------------------------------- ---------- -------------- -- ---- - ------------------------ DATE--------------------------------------------------------.---. BUILDING PERMIT 155UED------------- -- ---------- ------------------------- - -- - Alterations and/or recommendations---------------- ------------------------- ----------•----------------' ----------------------------------- ---------------------------------------------------------------------- ---------------------------- -- --------------•-------•----- ..- k ___________________________________;__.__._. ----------------------------------------- ---------------------------------------------------------------------------------- fDate ' - < ------------ ------------------------------- FINAL INSPECTION BY � ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO. �