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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .... ....... .A;.F. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thg 4work rein described. This application is made in compliance with County Ord'..a..-Q No. 549. JOB ADDRESS AND LOC TION ....... ------ _41i Owner's Name....... - --------------------------------------------- ...... ey ...... .... --- ........................ Phone...... Address._ --------------tom------------ ................... ---•----------•---•--•----•----------------•--------------........ Contractor's Name..j __A - ------------------------ .. .... Phone,4W Installation will serve: Residence 95o�<parfment House.[] Commercial E] Trailer Court [:] Motj;:] Other Fj Number of living units: Number of bedrooms ---lo'-Number of baths ..Z.- Lot size-----Z,7 7--------------------------- AP mo� Water Supply: Public system E] Commurfity system [3 Private nth to Water Table I�W. ft. I Character of soil to a depth of 3 feet: Sand [] ...Gravel ❑ Sandy Loam E] Clay Loam [3 Clay El Adobe 2r-'Hardpan El d Previous Application Made: Yes 0' No D,-,14;wcoiisfruction: Yes 0 No �A/V& Yes C] No ❑-'*—. TYPE OF INSTALLATION AND SPECIFICATIONS: • (No septic tank or'cosspool permitted if;'�u' blic sewerlis availabl&.within 200 feet.) _e7 Septic Tank-. Distance irom'nearesW WeII;_ _ 4 (0j -----Distance from'founjafion---- ........................ No. of compa4ments.......2w-------------Size.n. f�4 M..!!Liquid dep' ...... anc- ---nndafion.... *...Distance to'-'nearest lot line..f,-3.4.#** MoZosal Fj6t5_ Distance' from nearest-v7e'1176:P�'.'O.-Di'sf��eYro Number of I' Length of ea'cg line------$,/a.. ....Widthof irench._=X_$e.ek,� IL;., ............. ori material....../Z_�'___Total length......__._I-AY-0. ................ !..�y�e of __'_"Pth'of fiIT Dista�cl W ounclation,40.........Distance to nearest Iot*hne_.3_�0__e Seepage Pit: _ceNto`_n*e*jAr e M sta rzof Pts. A Diameter. -....Depth.....�2.�F2�............ Nambe ----------Liningmiateri, in II Cesspool; Distance from nearest est weil-..''�4k___Di,fance-776m foundation_________________-- Lining material--____._--_-______-__.-__._.___-____-. ElSize: Diameter_,J----_._-------Ll' Depth : -;"JI .............................. .......Li uid Capacity----------------------- __ Iqgals. Privy: Distance from nearest'a est well..........!....... -----------Distance from nearest buildi6❑ g-1 --------------------------------------- - Dis'tance to nearest lot lirie'_-x-----------............. ........................................ ---------------------------------- Rem delVg and/or repairing fdr t-—----- sc:ri +0w. ..... ti ----------------- ---------- -------- ................... .................. r --------------- ............I................................#--------............ - --- ---- -- ------------------ ............ -------................................................... ----------------------------- ................................ ---------fm..l..... -------------------- ------_--------------- ........................................................... I hereby certify that 1-have prepared this application and that the work will be dont, in accordan1ce with San Joaquin County ordinances, State laws, and rules and regulations ofifhe San Joaquin uin Local Health District. t (Signed ---------- ................... J.;47.. . ............ ontractorl 1 By:............. ......... 1 ........................---•----•-------•-......---•-•-•--•- - ----------------- ---------(Title)------......-. e i� ---1-------------------------------------------- (Plot plan, showing size of lot, locatioln of system in relation Wallis, buildings, fc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----•--.±.1:.......................... ...... .......................•----•-•---•--•-•------ -.- DATE- i....... REVIEWED BY........................ .......... ......5----- ..............i....------••-•-- ---- --------------_------------................... DATE ............... BUILDING PERMIT ISSUED--------------T--------------- - .. -••••••........._...................................... DATE :_•--: ------------------------------------- Alterations and/or-recommendaf ions:.............. ------------------------------------------------------------------------ ..............................................................................--- I——----------_..................................................................................--------------- .................. ...................................................................... ......................................................1.................................................. ....................................... .................................I........................I-----------............................................................................ ...................................................................... ........................................... .................... I......................................... -------------------------............................................................... ...... BY:.. ..... Date FINAL INSPECTION ........ ._- J/j/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Shoot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Califamia Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.