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APPLICATION FOR SANITATION PERMIT Permit No. ._to-1rt_�°_... (Complete in Duplicate) Date Issued _►Q""AP- Application O--'-�� A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pP This application is made in compliance with C unty rdinance No. 549. It E JOB ADDRESS AND LQC TON-___ --- q 1 7 Phor -:------- -- Owner's Name - F 091-F © f� � Address -rl2-- _ ../� '--C.-----A ------------- -- --i--1-.---•--. --------------- Con#r.acfor's Name- ---------------------------------------------------------�--------- Phone•--- �---------------- i Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer. Court Motel Other ' 3b Q------------------------------- Number ----------------------------- Number of living units: _�_-___ Number of bedrooms _ -- Number of baths -____ Lot size _-- _S--_-.- ------ Water Supply: Public system ❑ Commursity system ❑ Private, Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: 'Yes ❑ No New Construction:- FHA/VA: Yes ❑ No El '} TYPE OF INSTALLATION AND SPECIFICATIONS: ' {No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Material-- ----• Septic Tank: Distance.from nearest well---67o- --Distance from foundation__/_P__---_--- y i No. of compartments_._-e�.--=-------------Sizeto __6j -_Liquid depth_-$_�.._ --_-----.Capacity-� ------------- 1J Disposal Field: Distance from nearest well_ from foundat �_f¢____-._--.Distance to nearest lot line_.--___--------- _�Q-- --Distance ion_. - I Number of lines---•_-f-- y�,-�--,f-- Length of each line----$a*----------------Width of tTench-.�-_ --------------------- ----Total length -------- 0--------------------- Type of filter material._ --el?, Depth of filter material_- -`"__-_ _ �j '-------Distance from foundation--------------------Distance to nearest lot line---4 �.--___ Y See age Pit: Distance to nearest well_`- ____ Number of pits /----------- -- -a Depth - -Lining material--�L_ql�---------Size: Diameter--____- , p -- ---------- --Lining material-, ---------------=-'--=`�- -- Distance Cesspool: Size: Diameter nearest well from foun ation_----------------- Liquid Capac�#y-_-------------------------gals. - ____--_-Distance from nearest building Privy: Distance from nearest well---------------------�--: -----_---- --- ----------------------------------------- ---------------------- -------- --------------------------- .�,. t ❑ Distance to nearest lof-line------------------------------------------------------------------------------------- - a Remodelin and or repairing describe - �JrJ i 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, Sta a laws, and rules and.-re-Sulations gf the San Joaquin Local Health District. ------------------------- ( r Contractor) (Signed)---- ------- ------------------------Owner and%o 0 ----------==--------- - Ti#le----------------( --------------------------------------------------------------- By:-------------------------------------------------------------------------------------------------------------------- (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 /D s'' APPLICATION ACCEPTED BY DATE �.(� .� ---------------- - REVIEWED BY--------------------------------------------- ------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------------- ---------------------------- DAT :- i ------ ------ DAT.E-------------------------------------------------r=---- ----- • - � Alterations and/or recommendations:---------------------------------- ----------------------------- ------------------'---- -----------------------•----•--•------... ----- ----•--------•------------------------------------------------ ---------------- --- / INSPECTION BY:-A-4FINAL - Date_`.p J"�£---------------------------------------------------- SAN-JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streat - Stockton, California Lodi, California Manteca, California Tracy, California r l`ES-9-2M Revisep 1-57 F.P.CO.