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Permit No. __ APPLICATION FOR SANITATION PERMIT __�� S 2— (Complete in Duplicate) �,.t,�, • �a Date Issued T. 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. , JOB ADDRESS AND LOCATION------ . s3- s�ff/� 0 -------6allf. Owner's NameQtif --- ------ ------------------------- Address__ Phone - -3--------------------------------------------------------- Contractor's Name________ 3 - ---------- ----�-------------- - - -------------- -�-�'��---------------------------------- -- Phone--- ------------------------------- Installa+ion will serve: Residence aQ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other El � o Number of living units: _�----- Number of bedrooms ��_____ Number of baths 47- Lot size _73--X___J. �It,------------------------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water'Table ______:_ ft. Character of soil to a depth of 3 feet: SGravel E] Sandy LClay Loam, Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes E] No No New Construction: Yesoam No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest welL_Sf�—Distatncee from founnLajon u i a4'f"Mate ial__-- - _�:_ VQ No. of compartments-----2,.--------------=5jze-Yef I-.X -1 G - r p. Capacity- Disposal p ty Disposal Field: Distance from nearest well 5,0 stance from foundaticn__IQ�Distance to nearest lot line----`�!________.. Length of each line_ (� Number of lines-- --- g �--�a- �_r�y_ALvidth of trench_- --��_____________ r.. Type of filter material_- Q_ L _Depth of filter material----0_ ��______Total length____ _�_______________--__ W Seepage Pit: Distance to nearest well-----_----------_-----Distance from foundation--------------------Distance to nearest lot line-----_---__.__- _ F] Number of pits----------------------Lining material---------------_-------Size: Diameter------------.----------Depth---------.-.------------- --- Cesspool: Distance from nearest-well----------_------Distance from foundation-------------------.Lining material-_______....___-_____.___-________-_ V ❑ Size: Diameter--------- --------------Depth---------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------------------------- ___--------- Distance from nearest building-_._____________-_-_-___________________, ❑ Distance to nearest lot line-- ---------------------------------------------------------------------------------_---------------------------------------- -------, I Remodeling and'/or repairing (describe)------------------3a---------r/1mNaH---' A ----"—t4Cs---------- --X- --h._, 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 regulations of the San Joaquin Local Health District. (Signed) ------------------- ----- -------------------------- --------------- ---------------------------- ----------------- ------------------(Owner and/or Contractor) B (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R-[3E- TMEN USE ON Y APPLICATION ACCEPTED BY---_---- - `- .. ATE-----1�� e ` REVIEWEDBY------------------------ ----------- -------------------------------------------------------------------- ----------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ t Alterations and/or recommendations:-------------- --- ---------------------------------------------------------------------------------------------------------------------------------------- ----------------- ---- -----------� I if c T- ft til ---- ------------------------------------------------------------ ------____-_____________ [ `__-__�_ __- ___ __6{�... ` s^�A !:_ - 1R1.!'i_- yi_t_ 3 E-� /�=7�1` ____ . 1.r 6,6 I - � �`' '/b 'a: -------------------"--------------------------- �T - ---- -r------- - -- - ------------------------------------- ----------------------------------------------------------------------- - R� FINAL INSPECTI BY:- -- ----- -------- -- ---- -- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT K 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 , Revisea 4.57 F.P.CQ-