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FOR OFFICE USE: V------------------ ____________________________________________..____----- APPLICATION FOR SANITATION PERMIT Permit No. ./ �S---------- ----------------------------- _ :� (Complete-in Duplicate) Permit'.Ex�fires l Year From Date Issued 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 ''%4, JOB ADDRESS ANP LOC TION____ _--'_---- - ....- Owner's Name --' r.. . _-j.-r-� '--------------------- Phone---------•-•---------•---•---------- Address-----•-•--- `------- �_ ---•-••----- --------46e ..... Contractor's Name--- ------- - •- - ----- •---- -- -`= -- ----- ------------------------------------------.._ -•---.-_--_---__-_-__ Phone.... ........................ . . Installation will serve: Residence 2Ap�artment House❑' Commercials❑ Trailer Court ❑ Motel El Other ❑ OF Number of living units: � Number of bedrooms __ __ Number;of baths ___..__ Lot size ._ 4 s _ . _,_-0 ..i~ :r.. -. I i Water Supply: Public system ❑ Community system E] Private ❑,i-Depth„to Water Table ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sardy Loam lay Loam E] Clay E] Adobe C] Hardpan E] Previous Application Made: (ff yes,date-------------------j No ❑ ,°'New Construction: Yes F1 No ❑ FHA/VA: Yes ❑ No 171 a TYPE OF INSTALLATION ANDj,SPECIFfCATIONS: r. . (No septic tank, ror cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_->�v --'Distance rom foundation___ P� r Mate ial- _ ._.. No. of compartments_..___A-__.,::_"__,_Sizet _ _ f1.____.___Li .uid de th_.- _.----------- _ - . __Ca acit �� q i P y---- --- Disposal --Dispose Field: Distance from nearest'well. Distance from foundation::/JP�:-=:___:Distance to-nearest tot Number of-)ins------ .___ _ •length of each line- ___,XY_"��r Width of trench.__. Jr N Type of filter material/o . _ bepth of fil}er material___:�0_-*�- - Total length ••-- -. ,Y:= / - _-- _______ - •----------------------- Seepage Pit; Distance to nearestjwelL:A�YP__'- ----Distance from,foundat n.... ________-Distancetto nearest lot line ______._ f� 'Number of pits____----I---..______Lining matercaL_�-- ICr ._:Size: Diameter-I-�-X- ..___Depth_________.6__r_______________ Cesspool: Distance from,nearest well-------------....Distance from':foundation.__"°______._p-----.Lining material__---__.._____.___,_________________ E] Size: Diameters_--' ° Depth---- ==--� }; ---Liquid------ CapacitY--------------------------gals' , 1 Privy: Distance from nearest well ------------------------------ _ _ -_ ____. __-_--_---Distance from nearest building---------------.--------•......._________. l ❑ Distance to nearest lot line__.--_4_ -- r. . a .4 Remodeling and/or repairing (describe):_.___---- _- �-'_ - _--- y -------------» ---- - - -------------------------------------- ------- ---. _. 1 ,� a -- --------- ---------- -------------------- ------------------------------•------r--•---•--•---•-------•--- -- ------------ 1. r — ------------------------------------------------------- ------------= � - I hereby certify that I have prepared this application and that the wodwill be"done in accordance with San Joaquin County ordinances, State laws' and les-and regu ations of the.San Joaquin Local Health District. Si ned E 9 } ------- -- ------ (Plot ---- r Contract ------------------------- } By: = = (Title} d y -- ------------------- - AMS-_--------- ------------- (Plot plan, showing size of lot, location of sysie I relation to wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,' - ---------=------------------------- •------------ DATE------ -------------------- p- l BUILDING PERMIT ISSUED ------------------------------------------ DATE__ =----------- - -- - ---------------- ----------------------�_-----------+-----= - A Alterations a or rec mendations: k y - = "` = " _--- _--=- •-•-• == _:.. -------------- --------•---------- � 1----------------- sf` ��”``------------- ----------- -------------------------- --------- ------ ------ -------------------------- ----------------- ------------------------- -----------------------------------•---------------- - --=-- , -------------------------- ........... ............ ----- -- ------- - ---••--•-- ----------------------- FINAL INSPECTIO Date- SAN JOAQ NILOCAL HEALTH DISTRICT 130 South American Street } 300 West Oak Street ti,`124 Sycamore Street : 405 West 9th Street Stockton,California Lodl,California y s '�• Mante�a,,Califo1 0 � �. Tracy,California ES-9 REV113CD a-99 F.P.CC,81A 6.60 '