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I Q � APPLICATION FOR SANITATION PERMIT Permit No. ._f_�__�.. ....... r� {Complete in Duplicate} '7 E, Date Issued l Application is hereby madeai o the San Joaquin Local Health District for a permit to construct and install the ork herein described. This application is made in compliance with u ty Ordi ante No. 549. �I r �L � JOB ADDRESS AND LOCA -- ! ------- - r -.-. _ A '�' __. !/7_ Owner's Name----------------L�P9=r ----- - - ------------------- --- ; --------------------------- Pho ------------------------•---- f ! a � II -••--- ----------- --------------------------------------------------------------•----------------------------------.- Address- F .. Contractor's Name-------- ------- - -- ' Phone...- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court El Motel ❑ Other E] Number of living unit`ls: __ __t Number of bedrooms -_ Number of baths _/--_ Lot size -Ale_ 0��,y�_�___________________ Water Supply: Public system E] Community 'systemrivate ❑ Depth to Water Table _ ft. Character of soil to a dept of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I!I�Hardpan ❑ Previous Application Made: Yes E] No [ ` New Construction: Yes �o ❑ FHA/VA: Yes e'No ❑ p % ,w �k TNS TYPE OF INSTALLATION BAND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well _ -`�---Distance f om --------Material R ,� �,r --- -- ---------------- 2101, No. of t-ompartments------ Liquid depfh__ .------------Capacity_X��P0_.___ I Disposal Field: Distancd�from nearest well-------:- --Distance from foundation_-_ZV`--f--.Distance to nearest lot line--- Number ine_-- �_ Numberof lines------ ength of each line_____ 1, _f Width of trench.___ _ ,r_____________ _.. Type oflfilter maferial_� � ___ epth of filter materi ----------Total length____ _________________ _ Seepage it: Distancel�to nearest ggwell-------`-�-:______Distance f om fou dation__/,e__�.,Mstange to nearest lot line-- �-_-_- Numberl�of pits____ ---_-.,_____Lining material-, ��__�_ -Size- Diameter_-. _.�_____.Depth_._.a � I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__.__._____-_---.----.-------_.-_- I ❑ Size: Diameter-------------------------- -----------Depth----------------------------- ----------------------Liquid Capacity Y --------- ---------gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- 171 Distance to nearest lot line----------------------------- ------------------ -------------------------------------------------------------------- Remodeling -------------- -- -- - -- -- Remodeling and/or repairing (describe :------- ' - ----------------------------- ---------------- r - ----------------------------------------------`--------------.--- ----------------------------------•------------------------------------------------------ --------------------------------------------------------------- .I I hereby certify that F"have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ;rules and re lations of the San Joaquin Local Health District. (Signed) ='' ----------- v- ----------------------------------------{�r Contractor] k By�------------- :. {Title} � ` ---------------------- [Plot plan, showing size of 14, location ystem in relation to wells, buildings, etc., can be placed on reverse side]. up ;II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED!III Y --------------- -- .�NJJE----�r !IIIs REVIEWED BY----------------------------------------------- ---------------------------------- ------------------------------------------ DATE---:,--,< .;- -------------------••--------------------- BUILDINGPERMIT ISSUED� --------------------------------------------------------�-------------------- --------- = '= DATE . Alterationsand/or recommendations=---------- ---------------------- ------------ -------------------------------c-------------------- ----------------- ----- ---------------------------- - - I -- -------- -------------------•-------------------------------- ' " �} �� --------------------------•--------------------------------------- il ---- - ------------------ ---- ---- I --------------------------------------------------------------------------------------- ---- - ` 1------- " FINAL INSPBX1 = Date-------77--,7-7!-�_�75 ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 Nor+h "C" Street ` Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 Ep,co_ �>