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-.-APPLICATION-FOR SANITATION PERMIT Permit No. _�_ ------- t`T4� (Complete in Duplicate) }�C ' , ------ 2-::1 ----- D4lPs2:e 1 Application is 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. 14*r5 �G- ----------- ------� ----------------------- Qut �I' TT,c i . �✓ JOB ADDRESS AND LOCATyION�------------------------C----- '- --------- - -_- -- Owner's Name-------- Phone R = Address------------- ------' -- -----------=-----------------_6_d/-------------------------------- :-----.-------- Contracfor's Name -. .` !` �/7 -------------------------------------------- Phone =��' Q Installation'•will-serve Resid nce ❑'""'AparfinerR-House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ --- 'G 1Number of living units: =_w_ NumberIf bedrooms -------- Number of baths S_14� St size _______ ______ FS___,______ Water Supply:7— u@ic system'❑,.Co�munity system ElPrivate � D,epth;to`Water Table ft_ Character of soil to a depth of 3 fee+. Sand* Gravel EJ,,,,Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ElNoX New Construction: Ye No ❑ PHA/VA: Yes E] No E] Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No'septictank or'cesspool.permitted.if.public sewer-Ss available within 200 feet.) a r I♦. Septic T r Distance from nearest well _I�Distance;from foindat�ori_____S_d_'".."Materia-_ -_ �_=__ `_ __._ No. of compartments___ _______ Size_�6z _•�__--S�r,�_.Liquiddepth__-�a ___________Capacity-..�� _ /i ) / Dis os�l°Field:+ Distance from nearest welL�___�_Distance from foundation___ -/ f _ ________.D3stance to nearest fat line __r---------- i _________ P - .,r Number of lines_____:_____: Length of,each li}e_ -!____ ' _:_____.Width of trench__ _aff�__________ __________ '' '' t �} .� Type of filter material_Z!_iCg .__Depth of filter material__4�`_____-_._.dotal length___.,��.__.______.------- Seepage _l__--Seepage Pit: Distance to nearest well_____________________Distan from foundation__________._-:_.___.Distance to nearest lot line-- ___.______ �^ Nu tante from well_"Linin stance ' ❑ { P --------- Ig �--------------A---Size. Diameter----------------------Depth-----------------------_-------- � from fou r Cesspool: w �;` Dis � ---- -. ndation ---'-r----,- -.Li�ng.,materia!==---_--�=--�---- +-°---------- id -- --'--- (n El Size: Diameter------ ------------------- Depth ---------------J--------------.--------------- Liquid Capacity - _ gals. Priv Distance from nearest well___- I____________________________________Distance from nearest building-------------------- _________ -____.__ Y ^ * f ! I ❑ ,`'Distance fo'nearest lot-line------- = �- -------------------------------- ---- ----------- ---------- +� � -- Remodeling and/or repairing (describe):__l ------------- --------------- ` (r - jj __F_____________i /47 M�_____ __-.__ ___ _______.____________-___-___ ____ ____ _ _ _ _ !_ _ _ ___ __ I _______ �� _ �4_;` 4 - I__ --` ------------ --- ------------------------------------ ---------------------- --------- -------------------- I hereb ertif that I hav ai- this a kation and that the work will-be done in accordance with San Joaquin County 1 ordinances, to laws, and es n egulations of'the San Jo- g in Local Health District. t ned - --------- ° - - = - -: ----- her;and/or Contractor) . (Sig )_ By:------------------- -� ----------- --- ------ ----------{Title)-- - (Plot plan, showing size of lot, Iota ion of system in re lation to w i dings, etc., can be placed on reverse side). FOR-DEPARTMENT-USE-0NLY -t— APPLICATIONACCEPTED BY--------------------- ------------------------------------------------------------ DATE--=-------,, "''� --------------------- REVIEWEDBY--------_-------------------------- - ----------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-- ----• ---- ------------------------------------------------ DATE----------- ----------------------------- Alterationsand/or recommendations:-------:=------------------------------------------------------------ --------------------------------------------•------••--•-----------•-----•------------- ------------- ---•----------------------------------------•----------------- - -------------------------------------------------------------------- ---------------•----------------------------------------•-- ------ F _ _____________________________________ ______________ Y , w - w- ------------`- ---------------------------• + w FINAL INSPECTION` BY: -- --- -- - ' " W' - Date�� = SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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: ' - - '- ;a ,• - _ �'