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APPLICATION FOR SANITATION PERMIT Permito. --- 1/\ ( (Complete in Duplicate) 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. 549. ,_ f JOB ADDRESS A LO ATIJ - ---- ---- -- � -Gl. ----- ----------- Owner's Name d = ------------------------- ---------------------- ------------------ Phone.----------------------------------- Address-_................ Contractor's Name 'F �_-! r. Phone?-. -t5. �'[[ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---/- - Number of bedrooms __/--- Number of baths -------- Lot size _--_ _%--K._-_�.- 'Q.- '_____--_ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑. Gravel E] Sandy Loam Clay Loam ❑ Clay [:❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9KINew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if publicwer is available within 200 feet. Septic Tank: Distance from nearest well____` -�..--Distance from foundation___--- Material--_- C. k-elf _._--_---. No. of compartments-----7i--------------- .-:--.Liquid depth-477------------Capacify.g�--_-___.--. / p Disposal Field: Distance from nearest well__�s.._--_Distance fromcc foundaticn___Xo----- __.Distance to nearest lot line---15 .�--. �i Number of lines-------1-------------------------Length of each line------612--^----------Width of trench.o�_S«-----,------I------ Type of filter material---_______-`._---------Depth of filter material------------_---------Total length---------------------- --_--_._--_..--_- Seepage Pit: Distance to nearest well-------------------- from foundation--------------------Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material----------------------.Size: Diameter--.-------------------Depth--------------------------------- Cesspool- Distance from nearest well-----------------Distance from foundation------------------- materiai-____------------------.--________ ❑ Size: Diameter-------------------------------------Depth-------- ----------------------- -----------------Liquid Capacity-- -- ---gals. Privy: Distance from nearest well---------------------------------- --------------Distance from nearest building____.____---._--------------______-----. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- ----------------------------------------------------------------------- ------------------------------------------------------------•---------------------------------------------------------------------------------------------- -------------------------------------------------- -------- 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 Heq4th District. DAY A{NIGHT 1/Si(�ned11 ., ------------c..�A_ry r - r 4 7 )-------. _.. .... - iii r0z "efvi1c9-------------- - - --- --- _-_______-__ -_ __- _--- .- ------ w . a.r��:ry --32Q6 Sa.1<ldareedo--HO -T04- Title --- -- ------ By:-- :.. - ( } (Plot plan, showing size of lot, lo�ta`�io�19f s�iVVrb in relati n o wells;-buifdings, eto. can be placed on reverse side). FOR ARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- DATE----- -------------- wx- REVIEVJED BY � ---------------------------- - A ---------- DATE- - --•- Z----------_--------------------- BUILDING PERMIT IiJI�D------------------------------- ?-' ---- . — DATE- - -------------- Alterations and/or recommendations------------- - ----------------------- ---------•-------------------------------------------•---------------•------------ -------------------------- ------------------------------------------------------------------------------------- -------------_------------------------------------ ------ -----------------------I—,---------------- ------------------------------------------------------------------------- ----•----------------------------------------------------------------------------------------------------------------- ----------------------------- FINAL INSPECTION BY:. ----------------------------------- 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 fievisep 1-57 F,P,CO.