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I 1 B APPLICATION FOR SANITATION PERMIT Permit NS.-_? / � Com late in Duplicate) { P P Date Issued f \Applicafi`8n is hereby macre to the San Joaquin Local Health District for a permit to construct and install the.work k, rein described. f Thls application is made in compliance with County Ordinance No. 544. 1.. . JOB ADDRESS AND LOCATION_---- -- ----------- '------• ----_-- ------------ Owners Name--- .. . ••---•- •---- ... .......jt... Phone. 17 Address.__...///.f.�--•--..t� - --- -- -------- -------------- ----------- ..............---- .... _ ...... Contractor's Name--- ... ---- - .l..r Phone_ - 7 7 Installation will serve: Residence Apartm t House 0 Commercial ❑ Trailer Court;❑ Moltel Cher ❑ I .. Number of living units: Number of bedrooms ..L.. Number of baths,.,,j.._ Lot size .................... _. Water Supply:—`Public system J Community system ❑ Private ❑ Depth to Water TableZlft. Character of soil to a de0h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Ado b Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No�'' TYPE OF INSTALLATION AND SPECIFICATIONS: I 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel(,,.z�- _Distance foundation_.,./�L�___._._..Mater)al_._._.�.:_. . No. of,compartments--_,.Z.-------------Size__ 1�. �'_ _._:_..Liquid depth__... _--_.___-Capacity �_ 1 Dis oral Field: Distance from nearest Distance from foundation,,/_S:7;---------Distance to nearest lot linp._ Number of lines. ... Ler.gt� h�of each line....... a Width of trench._..•_. Type of filter material . . ....... ........Depth•of filter marenaL_-_- .4 Total length.,..------ 41, Seepage Pit: Distance to nearest wel ___...:__._:_.__Distance from fo ,dation___ .r't Distance to nearest lot line r Number of pits..... Luning material .__ .-___. .-_Size: Qiameter_..._. �r_.._..Depth........r1Z__...-- ------ ._ S Cesspool: Distance from nearest well._.A,.-_. Distance from foundation.__................Lining material...•_.- __-_.._-_.. __.__-__--- .1 { ❑ Size: D:a nater ._Depfh_...._.. Liquid Capacity gals. i" I ''privy: Distance from nearest ----_ --: ______---._:_Distance from nearest building................__..._.___.___.______- r _. ❑ Distance to nearest lot .......... ------- ------------------------ ---•- - - .._....-. -- - �► ! � -- Remodeling andjor repairing (doscriL�e),;,._� . _._ . _ __ __ ____ ----..-. ___.___ ....'�r^�= ------- `-= -- •---- � .._------------------••--------------------------••--------•-----•-•------- -. ----------- --- - -- ------- ---.•.•„_.._ --.------ -.._....... -.....- - -r 1 I hereby certify that I have prepared this application and a+ +he work will be done in accordance with San Joaquin County ordinances, S laws rules a re ations of t San quin al Health District. (Signed).__ .... ._ ',c-----•._ ...-- .-.__-: ----.._(Owner a r Contractor 1 By- ---- {Ti+I �"-�_.. --- ----- (Plot plan, showin o (o i n of sys em in.relation to wells, buildings, etc., can be pl ed on reverse side FOR DEPARTMENT USE ONLY f APPLICATIONACCEPTED BY_.....................•-----.._.. -----------------------_--___-_•.----------------•- DATE---•--.._.. � � -• ------------ BY--------- -----------------------•.-----...-- - ---------...--•---------...-•------ DATE--•--- - /..�'.. --------_-------- REVIEWED BUILDING PERMIT ISSUED - •-- - DATE.__. ;G Alterations and/or recommendations: - _,......,,.-= .... •----•-...... .. -.--- --------------------------------�..... ..._...... ------ --••-.------•--•------- ------ -- - _........................................... - ,.� ---------- j� -- ----- -- ----------- -_.._._...._-. ... - - ...... f,, ..... ��,,, FI'NAL INSPECTION Date- ' -.4-1-Ar.... ........ _ _ ....._._.--•---•- 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 FS-4-2M . Revised 1.57 F.P.C©. J� fio