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qq qq APPLICATION FOR SANITATION PERMIT Permit No. .Yl`j._-- (Complete in Duplicate) Date Issued --_7 ///s__7_- 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, S49, JOB ADDRESS AND LOCATION- � -"-"'- Owner's Name-_4 ---• ------- ----------------------- - --- -------------------------- Phone----------------•------------------- Address-----------4�/ -- . -------------------- Contractor's Name o1 -x 'I ^'f Phone Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/------ Number of bedrooms,,-- Number of baths I---- Lot size ____-7'�`t__x2_0�------ --------------------- �I Water Supply: Public system ❑ Community system El Private, ] Depth to Water Table �6_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2[] Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes R] No E] FHA/VA: Yes E] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j e' nk: Distance from nearest weh-----------------Distance from foundation--.-----------------Material------------------� - - y •e•r No. of compartments--------------------------Size-------------------------------.Liquid depth---------------------------Capacity--------•--- -- isposal 1 field: Distance from nearest well.-S_-_'___Distance from foundation-.A-d'.-------.Distance to nearest lot line__4.1--._-. Number of lines------ -_-___ Length of each line-A"---- Width of french--"'*�------------------------ j Type of filter maferiall" -......Depth of filter material---/ r-----------Total length-_! ..-------------------- Seepage Pit: Distance to nearest well----------------------Distance from f oundation----___-........__..Distance to nearest lot -line---.-.----------_ .,171 Number ofp,ts---.._-___:.----------Linin9 material-'-_-__-__.__�_----- -Size: Diameter-----------------------Depth---------- -------------------- I - 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-;i ❑ Distance to nearest lot line------------------------------------------- - ----------------•---------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------•-----------•-----------------------•-•---------- J 4 ---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.----------.-------- I hereby certify that I have prepared 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)---------- -- ----- �-e f- I f-� ---------------------------------------------(Owner and/or Contractor) BY2 h 'r ----•------- .. ---------------------(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 ot APPLICATION ACCEPTED BY -------- ------ ------------------------------------------------------------- DATE..7.7-;?�-T7----------------------------------- REVIEWED BY------------------------------------------------------------------------------------ - -- ---------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterationsand/or recommendations:--------=------------------------------------------------------------------------•---•------------------------------------ ------•---------•--------------•---- -----••----------------------•--------------------•----------------------------------------------------------------•----------------------------------------------•--•---------------------------------------•-------------� ----------------------------------------------•--------•---------------------------------------•--------------------------------------- -------------------------------------------•-•----------------------------------- ----------------------------------------------- ------ .! FINAL INSPECTION $Y:_-_,_y.-- # ------------- �/ f' V - 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 Revises 1.57 F.P,CO. {