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APPLICATION FOR SANITATION PERMIT Permit No. . _°` .��_. .._ . (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 Orrd�iinance 549. } 1 JOB ADDRESS AND+LOCATION. R r -- -------------- Owner's Name ------ ---- ------------------------------------ Fhone. -------------------- - = i� l fa ----- Address ---------------- ----------------- -------------------- ` Contractors Name------- '� ---------- Phoria ------- --------- Installation will serve: Residence .Apartment House ❑ "Commercial ❑ Trailer Court Motel Other __ Number of bedrooms ___ s f , Number of living units: __� Number of baths_ ___ Lot size __._' - /- r i w i Water Supply: Public systemCommuriity system ❑ Private'[] Depth to Water Table 'ft. Character of soil to a depth of 3 feet: Sand L] Gravel F-1SandyLoam ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ ❑ No i Yes Y Made:dNew Construction: Yes �No ❑ FHA/VA: Yes EJNo R— TYPEApplication Ma � l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.Tank or'cesspool permitted if public sewer is available within 200 feet.) � s� a Septi T nk: Distance from nearest well-Mm—Distance iom foundation---IP----------Material-_�'_6__Ofk - ------------- p n -- ----- �^^ - No. of compartments_----�--^--------------Si__-�3-- --�-�---------Lsquid depth-----'�_.fr------------Capacity-----�40A0,---00 F ' ' /*0__.____.Distance to nearest lot line___/i� ..- pisposal Field: Distance from nearest/ell /.k 14 .-'Distance.fcom foundation___/.�_f- 1 CY' Number-of"lines_______________ ____. ______ _ Length of each lire___-- Jr ........Width of trench------ _ :____---_____.._ e_ �_De th of fAter..materi I l'----- Total 'length_______..__ *Type of filter material `_ __ :______- p 6 Seepage Pit: Distance to nearest well___ �-Distance from f ndation-__' �__._-. :s an to nearest lot line____Li .... Number of pits------/- ----------Lining material---I _-- Size: Diameter__ -------_----,Depth--. -------------------- i __ Distance from foundation______._______._-_Lining material________________ __________-_-___..-c nce rom f -�: Cesspool: Size:Diameter nearestwell -- ----Depth-----------------"------------------------------- ._Liquid Capacity gals. ' ' Privy: Distance from..nearest well-------------------------------------------------Distance from nearest building-__---_--------------------------------- y ❑ I � Distance to nearest lot line- ------ ------------------------ -- ------------ --------------- ---------------- ---- - Remodeling and/or repairing (des"tribe)_---------_----�- ...... ` -----•-------------------------- TM ------------------ -----•---------------••------------- ----------------------- -----•------------=-_-- •------------------•-------------------------- -------------------------------------------•--------------- -------- t -------•------------•---=-------------•-----------------------------------------------•--- ------------ _______ I -------------•------------------•--=------ ----------------------- --------------- I -__•------- 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 re ulations of the San Joaquin Local Health District. I (Signed) ------------------_(8wtrer° or Contractor) =( -® _.. ---- �"�----------------- By: . Title " -------_----------------------------2- ofesystem � (Title) (Plot plan, showing size of lot, Ioin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------- - ------------------ ------------ 417 DATE DATE REVIEWED BY------- '� ] —� •- $11kLDl . PERMIT ISSUED DATE _ ----------- Alterafio s an /ar recommendati s: --- ---------------•--------------------------•--------•----------------------�---••- ....... --------- ----- -- ----- --- - = - � ----- - r •- ------------------------------ 7w r— FINAL INSPECTION $Y.._-_-:/_ ---- - - DateSJ_ --- --G � s " SAN J AQUIN LOCAL HEALTH DISTRICT t} 130 South American Street 300 West Oak Street - 132"Sycamore Street $14 North "C" Street L Stockton, Cafifarnie Lodi, California Manteca, California f Tracy, California t ES-9-21x1 , Revises 1-57 F"P,CO.