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(} 7 APPLICATION FOR SANITATION PERMIT Permit No. 1� s (Complete in Duplicate) /a-/ Date Issued ____!__SS_�_ 1i Application is hereby made to the San•Joaquin Local Health District for a permit to construct and install the work herein described. This appiicatiori is made in compliance wish County Ordinance'No. 549, 4,f•' JOB ADDRESS AND LOCATION./__ e----- l dhey .Vr Owner's Name-- -- ---------------- Phone--- C -------------- Address----------- 1 Contractors Name---------- - - --- - Phone. Installation will serve: Residence ®--_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/__kNumber of bedrooms -1 Number of baths -_/--- Lot size I. Water Supply: Public system ❑ ^Community system ❑ Private ®depth to Water Table-.�_'l�__ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E❑ No [j`-New Construction: Yes ❑ No ED—FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND.SPECIFICATIONS:._ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_F�G'-______Distance from foundation___/_�-___-____-Materiaall--------------- -------------------------------- No. of compartments_.__- --------------Size__, .? _ _ ...,...Liquid depth---_�)-'/-_-�----------._Capacity----( - ------ Disposal Field: Distance from nearest well_d�P_/-___.Distance from foundation__/e7-i..___.Distance to nearest lot line_.®__�. f Number of lines--------/---------------------- Length of each line---- --------------Width of trench---_A�F--------------------- 1f T se of filter � Depth of filter material____1 �_u� 1.1 --Total lenth______ __�___�___________________�____- _-__ _ See a e Pit: Distance to nearest well O `l ___ ---_ ____ _�___. sanceonerr ned© Number of s ------/------- --Lnin materia ----Size: Diameter__.?3_ ------__DePto Cesspool:: Distance from well________________Distance from foundation------------------- Lining material---- El aterial---❑ Size: Diameter J-------------------- -'------------Depth----------------------------------------------------Liquid Capacity----------------------------gal i Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building---____________________-__________-_-_--. ❑ Distance to nearest lot I line-- ----------------------------- - - 4- -- ---------------------------------------------------------- - Remodeling and/or repairingairing idesc - 1W --------------------------------ribe1:----________ - ---------------------------------------- ----------------------------------------------------------- --------------------------------------------------- --------------------------------------------------------=--- -- --- ----------------------------------------------------------------------------------------------------------------------------------------- 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. s t (Signed)---------------- - 4 — ziC,/ = r Contractor) Byi - - -- �L� Title - - (Plot plan, showing size of lot, loc on of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --- ---------------------- ---------------------------------------------------------- DATE__ } REVIEWED BY---------------------------•--_V - �------------------- --------------•--------------------------------------- DATE---. -------•------- BUILDING PERMIT ISSUED--------- -----------------•----------------------------------------------------------- DATE------. ------------------------------- ---------------- f Alterations and/or recommendations•----------------------- --------------------------------- - is --------•---------------------------•- -------------•-------------- ----------------------- ------------ 1 --------------------------------•--------•----- -•---------------------------------------------•------------------------------------------------------------------------------------------------------------ - -- •------------ FINAL INSPECTION BY:. --________ I ,rte:-- . ---• ------------- Date � 7_ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street F 300 West Oak Street 132 Sycamore Street $14 North "C" Straet I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.