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APPLICATION FOR SANITATION PERMIT Permit No. ..1__ _Q- _ (Complete in Duplicate) Date Issued 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 r / p f' JOB ADDRESS AND LOCATION::,"6-,q_1_*'_�I----RC/-----------------I`�''L__---------1�_`� _► -fs_ , Owners Name_---- __�frL,��',- "- y ------•-- tX -1' Phone Address----•--------------------------- --- �•�--"-- ----------------------- --- �`�s Contractor's Name w.: �n.,r+�s t + "7 4 ------- -- ------------ - e �----- ------------- --------- ---------- •--- Pon .------------ � -------- Installation will serve:.-Residence,. Apartment House ❑ Commercial ❑ Trailer Court ❑ Other ❑ -�_ ❑ Matel ' Number of living uni#s: __� umber of bedrooms a--'Number of baths _, _-_ Lot size __ __ 7 t� a4'�3------------------------ Water Supply: Public system D Community system ❑ Private't2F, Depth fo Water Table Characte f soil to a depth of 3 feet:I*Sand ❑ Gga el ❑ Sandy LoamjK Clay Loam Clay Adobe+❑ Hardpan ` ❑ Previous Application Made: Yes ❑ No' New Construction: )es No ❑ /VA: Yes ❑ No� FHA 4 TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or'cesspool 7nmiffed-if public sewer is available within 200'feet.) eASeptic Tank: Distance from est wolfC}__---Distance from foundation__,/0__--------Material______ No. of compartments -------- ~' P Q - Size -- --.Liquid depth------Y/� -----------Capacity...4gfQ-Q__ Disposal Field:' Distance from nearest well______ :_Distance from foundation_Z�_-_.____.Distance to nearest lot line___ Number of lines___._ --_ Length'of each line--------�.. ._ ' C}"P_--------Width of trench---- ____ ----------- Type of -Filter material_�&eZ..---_Depth of filter material" _ ,iv---- �� Y ---- - •c --------Total length---�11�----=----- ' ------------------- eep❑age Pit: DistaNumbneceotf nearest well-------"Linin --Dist alce from foundation"-___________"_-_-.Distance to nearest lot line______________ P Lining -.Size: Diameter-----------------------Depth esspool: z Distance from nearest well_________________Distance from foundation--------------------Lining material_..__-.___-________"-""_""-_ " ----- f ❑ Size: Diameter_ Depth -------------------------- ----- ------Liquid Capacity-- -------------------------gals. Privy= Distance from nearest well " ...................... --_ _ --- _Distance from nearest building i : ❑' � _ Distance to nearest lot line_________ ________ -1 --------------------------------------------- Remodel' g and/or repairing (describe`�+ .�.+ � ---r --------------- ----- -------------- . - --- ------ -------------•-------`--------- ------r- ------- '-`� s —P = -----------------------ereb certify that Ihave - -=----------------------------------•--------------------------------------------------------- -- - ------------- -- - - --- =�=- - ----- --- - - --- Y Y prepared this application and that the work will be done-- --in--accordance-- --with- --San J-oaq. - uin--C-ount- y- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- "----- ---------------- ---------------------------- A.--;Yat-------- -- -- ---B_hllo- ----- " -- (Owner and/or Contractor) BY:------------------------------------------------- - Tale (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 r APPLICATION ACCEPTED BY-----------""__-- _ -- ------- - a I - --------------------------------------------- DATE---- REVIEWED BY----------------------------------- --- - --- -------.. - --- ------- ----------------------------------------- DATE------ = --_�- BUILDING PERMIT ISSUED---------------------- ---- - " - .----- -- - DATE Alterations and/or recommendations:__.______'_____"" QQ.__."____-"--___/y_�_-"-"_""_-""______________________.__--___. . _ -3- - r!\_____________ _____ _____ ___"_.-__"""__-.______.____ _______._____._____-_______.r___._.___ _ .."""_.-.""_. _ __ __ __ -511 _ --------------------------------------------------------- -------- FINAL INSPECTION BY_____________ %; ------------------------------------------ Date----- 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 , Revised 1-57 F.P.Co.