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-7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __q---- ----------- [ Application is hereby made to the�San Joaquin.Local Health District for a permit to construct and i sta the ork herein described. This application is made in compliance-with County Ordin nce No. 549. ' JOB ADDRESS AND—LOCATION--- �,�� Q:��Q___ �sj _ � ,,r Owner's Name:------ $'74�--- -�z-Oj = = --------------------------------- - Phone -~ Address-------- ------••- ... f_ .__ _ 1'___Q !.SJJ� } [",-,_____,= = - --------------------•-•----------------------------------- Contractor's Name... - -- --� 4-7--t + Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court El Motel EI - Other �n Number of living units: ______ k Number of bedrooms ________ Number of baths -------- Lot size, G -ip________-________________________ Water Supply: Public system ❑',Commun'ity system El- 'Private ❑ 'Depth to Water Table ft. Character of soil to aAepth of 3 feet: -nd ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rrl�`ardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ;2�0' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewerjs available within 200 feet.) c� Distance from nearest well---------------- Distance from�foundation--------------------Material _--_____ ---------------------------- -________- No. of compartments- ----------- - - ---Size---------------------------•----Liquid depth--------------------------Capacity-••-------------------- D sal Field: Distance.from nearest .well____--------------Disfance from foundation--------------------Distance to nearest lot line________-_--____. ta4�" Number of lines_---------'-----------------------Length of each line------------------------------Width of french-_------_----------------------__-- Type 'of filter material-------------------------Depth of filter material--- ----------------_Total length----- -•-----•_------------------------- Seeps a Pit: - ,. . Distance to nearest well_,tjD7WJ____f3istance from rfoundation__,C___e._�.___.Distance to nearest lot line_-_ ---- Number of ts-__.___ Linin ma+erial__ O�l. Size: Diameter_-_ 6 l p g �i Depth. T -------------- 3 Cesspool: Distance from nearest well-----------------Distance from foundation__-__-- -- :.Lining material_'------------ _____-_-_______-__. C , I ❑ Size: Diameter'-------------------------- - ------Depth------------------------------------------- -----Liquid Capacity = gals. i Priv Distance to nearestelotVlinle:___-_ ------------------------------------Distance from nearest builclin Y' Distance from Remodeling acid/or repairing (des crib ---- •---------------- ---------------=- --------------•--••----------- ` 1 f c t _ -- -------------------- �G -=-- = - --------------------------- ------------------------ ------ --- . _ _ ----------------------------------_ __________ _______________ ___ ____________________________________v___..-_- --_________-_____-----------__,.--------------- -___________________--___-- I I hereby certify that I have prepared This application and that the work will a done in accordance with San Joaquin County i ordinances, State law , a rules and regulati ns'of +he San Joaquin Local Health District. Y , ---- t Y . (Signed r- C'--`- r%nelfer Contractor) �. s - Awree BY•--------------------•-=----------,------- •---------------------- ------------------ - --- -------._� _ ------(Title)------------••-- `--------------------------------------- (Plot plan, showing size of lot, location of system in relation w IIs, buildings, 01 can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY____ _ _ _ ©_ ��-- DATE = ---------------------------- REVIEWED BY------ --------------- --------------------------- DATE----------- = BUILDING PERMIT ISSUED--------- I ------------------------------------------------------------ DATE------------ = Alterations and/or recommendations:- f -------------------- ------------------------------- --- ------ j =-----DEM l------- o� ` ',- -�_`_2 _--------------------------- ---------------------------------------------------=---------- --------------------------------- -- ---•---- ------------------ ---- } FINAL INSPECTION... '. = Date_-_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-21x1 ' Revises }-57 F-P,CO_ J�