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S1 ti APPLICATION FOR SANITATION PERMIT Permit\No. 4..2TL_ (Complete in Duplicate) t / Date Issued __/1_�7___�_� 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. - n JOB ADDRESS AND LOCATION----------6-------- -------- Owner's Name. --- 41� 19 b Q Phone.--------- ------------------------------- --------------------------------------------- Address----------------- Contractor's Name-------- �_1'C-.� f 1---------- ------ ----------- -------------------------- -- Phone................................... Installation will serve: Residence ,5--Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/ -. Number of bedrooms _`... Number of baths _-/___ Lot size .------ __ __. ..�_.`f _____________ Water Supply: Public system V�2 Community system ❑ Private.❑ Depth to Water Table -64fft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0_ Hardpan ❑ Previous Application Made: Yes ❑ No D- New Construction: Yes ❑ No 25-- FHA/VA: Yes ❑ No P; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well; ✓0-W Distance ron) foundation.___/C`I_-____-MateriaLf_G.G �Q/Gl�___ _- �� ----------Liquid depth------t__'_-G- ------Capacity.____.?-.o----- �. No. of compartments_____.�_�_.___.____Size___._ _ ._.__. Disposal Field: Distance from nearest from foundation____/ ____ Distance to nearest lot line._- ------- Number of lines-----.._____!--- Length of each line___:__tD_._ t{-___.Width of trench______.. .r__ ___________ f f n ----------- 0.T _(____.Width of filter mate ria!__/� ___5A Depth of filter material.___-/- ---____.__Total length---------�-0_____________________�. Seepage Pit: Distance to nearest well._IV61✓�_Distance f m foundation----/�_�___.Distance)o nearest lot line---�_ a-.-___ Number of pits_______-_.___._____Lining material._. - __G<' Size: Diameter i - 3 - Depth ----------- Cesspool: Distance from nearest well-----------------Distance from foundation.--_--------- ------Lining material--------------------_-_-_-____----_. ❑ Size: Diameter ------------------------------Depth - --------------------Liquid Capacity-------- ------------------- ________________._-________----.____Distance from nearest building------------------------------------------- Privy: Distance from nearest well-------- ❑ Distance to nearest lot line----------------------•-----------------•-----------------------•----------------------------------------------------------------------------- Remodelin and/or repairing (describe):--- ----------------------•-------I---•---------------------------------_..,.----------- ---------------------------- -r----------------------- \ g \t�\C --------------------------•---•------------------------------------=----------------------------------------------------------------------:------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. --------------- O (Signed) --- ------- ----- -�---- _. - (Owner and/or Contra l l - --- ��-+- -- -------- ----- - --------------(Title)--------19� -- Contract ----------- - (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-------------------------- `'�� DATE REVIEWEDBY----------------- ------------------------------,----- ---------------------------------- DATE------------ -------------------------- .. ---------- � . , DATEBUILDING PERMIT ISSUED---------------------------------------- -- -----------------------•-------•----- � Alterations and/or recommendations:- -- ------------ ----rZ------------•-----------•---•-----•--------•------------ --------------- ----------- -------------- ----------------------- - � --- ; ---------------------- ----------------------- --------_------- e-------------- , -------•------•---------------------------•---••--•-------------•--------------------•------ -------------------------------------------------------------------------•----------------------------------------------------------------------------------------- DateFINAL INSPECTION -----------_---- -----`----- --------------------------- --------- 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 Reviseo 1-57 F.P.CO.