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APPLICATION FOR SANITATION PERMIT Permit No. --------------- (Complete in Duplicate) Date issued _-VA---/may Application is hereby made to the San Joaquin Local HealthN Dist rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549, ----------------------------------------------------- --------- f- JOB ADDRESS AND .LOCATION-----IK ---- ---- -- -------------------- ---------------------- - Owner's Name----------------- /9,P--- --- I -- ------- --------- ---------------------- --------- Phone----- --- - 'ot&'I--- -------------------------------------------------------I-------------- -------------------- -----------------I--------------- ----------------------•-------------- Address--------------------19 Phone-------_----------- ------------- -------------------- s Name----- ---- ----------- Contractor' 1. Trailer Court ❑ Motel ❑ Other 0 Installation will serve: Residence Z.,Apartment Hou''a ❑ Commercial ❑E] -----------1-------------- edrooms Number of baths __/--- Lof size Number of living units:.-/'-- Number of b 0- -9/ft Water Supply: Public system 8"'Communify system- ❑El Private D 'Depth to Water Table Sandy Loam El Clay Loam 0 'Clay E] Adobe Hardpan 0 Character of soil to a depth of 3 feet: Sand E] Gravel El S ❑ n: Yes gg- No n FHA/VA-.Yes NO Previous Application Made: Yes n No ggo"ONew Constructio TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or'cesspool permitted if public sewer is -------- foundation--- ------ --- ----!: �IPAWID i Material -.i Septic T A: Distance from. nearest well_ 7.-X-"va-------Liquid dep.fh--. ---------Capacity;- W nis._-.1—---------------Size_j No. of compartments----- — . 1409--l' iearest lot 11-Ine---1$--------- nearest wel1*A_V/__:Distance from"foundation, ....Distance to i ;Z.� ----- Distance from / Width of french _._q�--------------- -(P Disposal Field: - ------- f:f) *_-i7h -- L4 Number of lines-------/------ ---- —/Length of each line W- ------------Total length________-F---------------------------- -filter -1:4material-- 47 , _jVAI�IA Depth of Type of filter material ;f 1- ation--- t nearest lot line-- ----------- - well- _ Distance f found ...Dis nce o PAI s an e Seepage Pit: Distance to nearest w t r T -------Depth----Ai�o------------------ I W -_ _-Eize: Diameter'-, Number of pits------/------------Lining materia r --.-__..--__--- -Li ------------------- --------------- nearest well-----------------Distance from foundation.-----__------ ---Lining material, Cesspool: Distance from. -----------------Liquid Capacity---------------------- •---gals. Size: Diameter------------------t------ ---------Depth ---------------------------- ---------------- 0 - — .. . ' Distance from nearest buliding-------------------------- Privy: Distance from neeirest well --------------------------------------- --------- ------I-------- ------- --------I------------------------------------------------------❑ Lo D;stance to n _'.------------earest lot line------ ----------------------------------- 4� ze _f-------- -------------- - Remodeling and/or repairing (describe) -------- ---------------- ---------- ---------------------------------------------------------- ------------- -------*-;-------------i----------Y------------------------------------ ------------------------------------------ ---------------------------------------------- ------------- __,,o .07 ------------ ..4ZZ__W ---------- ---------------------74P--- -------- -------4 --------- --------------------------------------------------------------------------------- ----County ----- --- - ------ --- ---- - -------- ---------I hereby- - __certify_.that__I_.have m prepared i-his application.-and that the work will be done in accordance with San Joaquin and les and regulation of the San Joaquin Local Health District. S. ordinances. State laws, and I pwtv-�y�or Contractor) -- - - ----------- ------ ---------------------------------------------- --- -------------- (Signed)---------------- ------ ------------------------- By:--------------------------------------------- i.e� wells,-buildings, etc., can b i e placed on reverse side). (Plot plan, showing size of lot. I . ion of system in relation to -FOR DEPARTMENT USE ONLY DATE-----9 1 ---- ----- - - ACCEPTED BY------ -- - - - ------------------------------------------------------------------------ I. DATE-------------------- ----------------------------------- REVIEWEDBY---------------------------------- ----------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------- --------------------------------------------------------------------- - (or rex�mendations;---------------------------- ----------------------------I------------------------------------------ Alterations and/or -41 e ------------•---•--• ------------------------------------------------I---------- r, 14------ ------------- ---------------------------------------------ff. K�J---------- ----------------------------------------- -------------------- ----------------------- ----------- -----------�L------------------ --- -------------------------- �J, � �/ --------------------------------------------------------• --------- P_ __- ------------------------------------------- -----------I- ------------------------------------- -------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -------- --------- ----------------------------------------------------------------- � -------------- Date ----------- FINAL INSPECTION BY:_.' APP DAT ---- LICAT[O`NAqCZEPTED BY --- ------------ Fj SAN JOAQUIN LOCAL HEALTH DISTRICT -_-1 814 North "C" Street 300 West Oak Street 13� Sycamore Sfreei 130 South American Street Tracy, California Stockton, California California Manteca, California 5_9_2M Revised 1.57 F.?-CO-