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;��,��' ►� APPLICATION FOR SANITATION PERMIT Permit No. .--- ....... V yt (Complete in Duplicate) ___ __� �1 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. 549n��77Q,v5 JOB ADDRESS AND LOCATION e---A4aoft------'---AP------`-5-30---PA6Z-- 4---------- ' E,f Owner's Name--------� '/4 1 L---------- 14_ __ _1a/�J--------------------- -------------------------------- -------- Phone. Y� 41K Address-----------------4:1_4 4.tv� - ....- Contractor's Name-------------------- ------------------------------------------------------------------------------------------ Phone------------------------------------ Installation will serve: Residence V( Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rr Number of living units: _/-.____ Number of bedrooms __'V_ Number f baths -------- Lot size __/_ �___.�� —R�______.___�._-_ - Water Supply: Public system E] Community system ElPrivate Depth to Water Tablel�__S'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cl a Loam E] Clay 11 Adobe Hardpan ❑ Previous Application Made: Yes E] No � New Construction: Yes E] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sepnk: Distance from nearest well--%5(9-------Distance from foundation-../(O----------Material_'a�_-*jC1Qt_'o--------------- ` No. of compartments-----------r------------ Size �` `�---------Liquid depth--------`K--I---------- P y•-•- r _Ca acit jq '7 / -------- -s f , Disposal Field: Distance from nearest well___��______Distance from foundation____ __�_.�__.___.Distance to nearest lot lin Number of lines------_____.4 ___ ____________Length of each ------Width Width of trench a- ________.____ Type of filter material__ -Depth of filter material_____Le...________Total length--------- ____/_iv-__------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation________}______.-..Distance to nearest lotline----------------- Number _____.___ _--Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-----------------_- ------_--- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material___.___-_________.__.____________. ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity- ----------------------- -gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------------------------------- p Remodeling and/or repairing {describ,g):__�LLs___W- _ h - •-Pao__- a 1s.Ms�.!- ---.--. �f. -- - r a a_kL_a-1-.►-0-------------------------- ---------- -------- ------------------------------------ ------------------------------� ------------------------------------------------------------------- I her y er�i, that I hav repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed). r ^^_ -�..�----------------------------------------------------------------------(Owner and/or Contractor) By:---•-:�----------------------------------------------------------------------------------------------------------------------------(Title)---------------------------•------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- ---------- DATE-------------- -------------------------------- REVIEWEDBY- --- ----- -------------------:---------- --- --- -- ------------- ----------------------------------------------- DATE--- ------ ---------------------------------------- BUILDING PERMIT ISSUED._.. DATE 1---------------------------------------------------- Alterations - --------------- -------------------- p_ Alterations and/or recommendations - --------------------------._ ------------- ---------••-- - ------•-------•----------•c- 5-�- -4_ -' e - ..J.--„ cep ,----- � ) ......... L. •W - .--.P�_..�" --�-.�..1-------------------------- ----- - -- ---- --------- ------------ FINALINSPE , IONBY---------------------------------------------------- ------------ Date-------------------------------------------------------------------------------- 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 ES-9-2M Revised 1.57 F.P.CO-