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APPLICATION FOR SANITATION PERMIT Permit No. ,l,,y �• (Complete in Duplicate) Date Issued 1 ns Application is hereby made to the San Joaquin Local Health District for a permit to coruct and install the work herein described. This application is made in compliance with County Ordinance No. S49. 4060 S_ 8c- 97- ' (0 , JOB ADDRESS AND LOCATION I y* _ Owner's Name---- -- ----- ---- ------619 --------------- ---- ....................------------------------ Phone.................. Address Contractor's Name_______________ ------------------------------------------------------------••--• --------------------I——----------------------------- Installation will serve: Residence El Apartment House E] .................. Phone Z110-----ef,0107- Commercial El Trailer Court E] Motel F] Other 0 Number of living units: __/__ Number of bedrooms ---k�'Number of baths ....tkL0?Ae__T_A;------------- Water Supply: Public system Ej Community systerin (j Private �Pfh to Wafer Table vwft.1=10 1-4 Character of soil to a depth of 3 feet: Sand ED,.Gravel E] Sandy Loam E] Clay Loam 11-61ay 0 Adobe El Hardpan Previous Application Made: Yes 0 No New Construction: Yes [_1 No Ej FHA/VA.- Yes ❑ No ❑ E- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if poV17wer is available within 200 feet.) Septic T Distance from nearest we�11_0-------Distance from foundation-_ /00 ----•--..Material---- ------- No. of compartments------- uid dep.th---151-Z-21!!_._Capaci ------ ...... ------ ---Liq e�.. -6 ", Disposal Field: Distance from nearest well,*_ kZ _ ... Di'sfance>4- from foundation_k------- Distance to nearest lot line_..__.�,d Number of lines Length of each line_X .---_..... Width of of french--- /00 ------ Type of filter material.._ Depth of filter.mafer;al....... ........Total length- 4 -A- --- ------------ Seepage it: Distance to nearest well Z OA ---7----,s -- --- ---0-0......Distance from founclationj.0.. ......Distance to nearest lot line-.N Number of pits.--_-1................Lining maferial__10N_f-c__1 ___ _Size: Diametier._Z._��_..Depth...QZO ............ ----------- -------- Cesspool: Distance from nearest well________________ fror) f, ---Distance fro foundation---_---------------Lining material_.._.__,_____._.__._ ------ O ❑ Size: Diameter------•-------------- ----------------Depth--------------------------__----- ---_-------Liquid Capacity-------------- .........._9als. Privy: Distance from nearest well_____________________________________-_ __._._..Distance from nearest building...................... ------ F1 Distance to nearest lot line...................... Remodeiing and/or repairing (describe): -------------- ---------- -------------- ...................-------I--------------------------------------------------------------------------------...................... ------------------------------------------ -----------------------------------------I---------------------- -------------------------I---- -------------- ----------------- .... -----------------------------------------I................................... --------- --I---------- ------ ------- ----- ---------- ------- d f the work will done in accordance with San Joaquin County I hereby erfi that I�.v. -------------------------------------------------------------------------------------- --••----•-•-••-----._.. --------------- pre a d this application an ordinances, St a s an an gulal -f W .rules an gulafions of the San o ui.n Lo al Hea District. (Signed)--------- --------------- -------------1,CLt0_e_r-_a;;44at C By:------------- of plan, showing size of lot ontractor) (Pl --••------•-----••-------••----------------........ {Title). _ -------------- location of system in relation wells, buildings, etc., an be �acecl on reverse side). FOR DE TMENT USE ONLY APPLICATION ACCEPTED BY I------------------ DATE REVIEWEDBY..�------------------------------------ ---------- ------- -----------------__ DATE BUILDING PERMIT ISSUED------------ --------- ------------- ---- ----------------------t_- Alterations and/or recommendations:_____--._.._.---- ------------ DATE... . -- -------------------- -- --------_-- ----------------------------------------------------------------------- ------.............I............... _ ---------------------*---------------*----------*---------**----------------- ----------- 47...........i ------------- ---------------------------------- ----------- ------------------------------------------------- ................. ............ ------------ ------------ ---------------....... .................................................. FINAL INSPECTION BY:.._--_ __ S- -_ 1 Date. 1..�._-...cal._ _-..-'a.7 Y:------ - .7----- - ------------------------------- -- 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.