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r APPLICATION FOR SANITATION PERMIT Permit No. ._. - -c (Complete in Duplicate) Date Issued _//)4 A 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 Po. 549. ; . _ ------ - -- �'_"-------------------- ------------------------------ .•----•-----------•--•----•---••-- JOB ADDRESS A LOCATION_____,��---- - Owner's Name-- ca-� -:� f- -------- ~ea ---------------------------------------------- Phone Address :f - - ----- T----------- ---------------- ` y J_7 o 0 Contractor's Name------- --------------------- --------------------------------------------- --- Phone_-,�4Z---•--------_--9-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ 5�._ _ -�La----- I Number of living units: _:__ Number of bedrooms " -- Number of baths ___I__ Lot size ___ _ � -'-- - --- ------J----------- )e Supply: Public system.Community system ❑ Frivate ❑ Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy'Loarri 'Clay Loam ❑l Clay ❑ Adobe4K Hardpan ❑ Previous Application Made: Ye{ ElNo New Construction: Yes No ❑: FHA/VA Yes El No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i ,_ I.. Septic Tank: Distance from nearest well_"_'`"'__Distance from foundation_ _ Mat�rial_ __ �� _---- ------ I r No. of compartments_____•� ----------------Size--- , Liquid depth--- C----.....--------.Capacity.,- -1 -----.. Dispos I Field: Di-stance from Barest weiL� -1 -._Distance from foundation__ 9 __:Distance to nearest lot line•_- r� Number of.lines______�__ /� Length of each line___-3p --- Width of trench_____ _ ____________________ Type of filter material_ G_-_r.__Depth4of filter mate ria l__-f- "_______Notal length-_------------- ---- Seepa e Pit: Distance to nearest well _' " __Distance f om f u ori:Em y�-.Dist ce to nearest lot line_.".___.__. " rze: r__7_ d"_ __ -'Depth_.�.__�_�jNumber of pits-----/------ ------Lining mated-- --- ' � Cesspool: Distance.from-nearest ell "^"""" ____Dista cc ro ou dation___________________Lining material____._.________________._______-___._. , ❑ Size: Diameter-- ---------.v � ------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ______________--- -----------------------------Distance from nearest building__________________._______.____-------.-- `1 Distance to nearest loOine---------_--------------- -- - } -* --- Remodeling andor -e Ginn describe ------------------------------------------------------------------------ ..,r".,,....� `-------------------- A, r `-•,»•� •--------------------------------------- 4 } ---- ---------- -----------------------------:-------------------;-------------------------------------------------------- I hereby certify that,l have prepared this application and that the work will be done in accordance with San Joaquin County ,\ ordinances, StaWIaws;�ancJ rules and regulations of the San Joaquin Local Health District. --------------=-------- -------•--•--------------(Owner and/or Contractor) � (Signed] ityct I ------------------------------------------------------------_ R___:_(Title)--•--------•--------------------------------------------------- k (Plot plan, showing size of lot, location of system in relation:to wells., buildings, etc., can -be placed on reverse side). ��,�..�,,......__ .... """c'� '.�."«�'..-.emirs. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ' )ATE" r' i: REVIEWED BY------------------------ --- --- --- ------------------------ DATE------. r... _- BUILDING PERMIT 1SSUED------------- ------- DATE ----- = Alterations and/or,recommendations:-- -------------------- --------------------------------- ------------------------- --------------------- -y --- ---- 1 ; ------------- ------- -------- - Y- -,6 ------ L' -- --------- - Date_ _._ F1NA1N PECTION BY:------ .�1.-ems.-- ----------- •-----=------=-----=-._..,. _ . - I r�=- �-�-�-`-��------------------------ =----------- y e' /�� S SANfJOAQUIN LOCAL HEALTH DISTRICT 130 Soath American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i E5-9-2M . Revises 1-57 F,P.CO,