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/(� ICATION FOR SANITATION PERT Permit No. iE (Complete in Duplicate) Date Issued --------/_1- 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 compliance with County Ordinance No. 549. ZUd- &-.t4T 4r mi" 2J q-e?-I--- ( - , ' ' * JOB ADDRESS AND LOCATION------ ------ -4-- Owner's ------------------------------------------- ------------------------------------------- Phone__��apdo-------- -7.22-320 Address--------------S� --- ----------------------- -------- I � 7 Contractor's Name. wq---i, ----- ------- -------- --- -------- --- ----- ......... -------------------- ---------------- Pho6e--!- F Installation will serve: Residence E] Apartment House E] Commercial F] Trailer Court E] Motel El Other Number of living units: -1---- Number of bedrooms Number of baths Lot size FWater Supply: Public system E] Community system Ej Private El Depth to Wafer Table 41�� ft. Character of soil to a depth of 3 feet: Sand E] Gravel I-] Sandy Loam El Clay Loam [] Clay [] Adobe ff"Hardpan 0 Previous*Application Made: Yes E] No 0 New Construction: Yes E] No E] FHA/VA: Yes F] No F1 TYPE OF INSTALLATION AND SPECIFICATIONS,. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sr Distance from nearest well__________.___Distance from foundation___________________Material-________._.___.________-_________._.-_._____-__. ' No. aterial------------------------------------_----------- No. of compartments--------------I...... Size_____ Li depth--------------------------Capacity----------------------- isposal Field: Distance from nearest well--I J----------Distance from foundation___ V ------Distance to nearest lot line- Number of lines--- Length of each line--- Width of french--dafim!-----I- ------%te, `'_______Total length----------------/------------------- ---- {i___ Depth of filter maferiamaterial-__l - ------------ Type of filter maJ',aI3,_ -_ See5ie Pit: Distance to nearest --------- Distance from foundafion__/P__ Distance to nearest lot line--/ .... Number of pits----I---------------Lining material---1K_0_C_k------Size: Diamefer.--.3-3.".......Depfh--..---?--J------------------ Cesspool: Distance from nearest well-----------------Distance from foundation...............-_.Lining material__.____._________.._-____--_____ ❑ aterial---------------------------------0 Size: Diameter-------------------------------- ------Depth------------------------------ --- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------- - -------------Distance from nearest building________-__----______________._.__._._- . .. .-❑ - -Distance uilding------------------------------------------ -Distance-to nearest lot ----------- Remodeling and/or repairing (descrit.!;i��,j------ --------------------'a F] ---------------I-----------*-------------------------------------------------------------------------------------------_------------------------------------ ---------------------- ---------------------------------------- ------------------------------------------------------------------ ----------------------------------------------------------------------------------------�:-------------------------------------------------I------------ k F -------- -----------------------*-----------------**-------------------------------------------------------------------------*------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules and regulations of the San Joaquin L Health District. [Signed)------ - ------ ------- . - ---------------------------:--------------------------------- Contractor) By:------------ ...................------------------------------------------------- ---------(Title)----------------------------------------------- ------ F -Xt4' 7 -- - -14 V (Plot plan, showing size of lot, location of system in relation' wells, buildings111104C., can be placed on reverse side). FFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�1.1,------------------------------------------------ ---------------------------------------- DATE_; a:: ---------------------------- REVIEWEDBY----------------------------- ------------------------------------------------- ----------------------------- DATE V_Z� --------------------------------------------------- F, BUILDING PERMIT ISSUED_________---st--------------------------------------------------------- ------------------------ DATE.--- —_____________ ._ and/or recommendaf ions:-------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- J -------------- -------------------------------------------------------------------------------- F ------------------------------------ ------------------------------------ ---------- - ------------------------------------------------------------------------------------------:-------------------------- ----------------------- ------- --------------- --- ------- - ------------------ --------------------------- ------- ------------------------------------------------------------ -------- - -------------------- V., FINAL INSPECTION=-BY: ....... ------R_.l__ Date........ -- -------- -- ---------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California FES-9-2K4 Reviseci 1-57 F.P.CO.