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I"1 Z APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) .!� Date Issued _.. la�� 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 LOCATIO ._. { � falaa._C.lGwa: " Q ' - Owner's Name - 18A ................... - ------- - -- - ---------- ----- Phone.;l��....IvInq....... Address � 'd2- �+ 41?_"141101 !l1 ` ---- � �� p Contractor's NamC — ---• .lf-___ .�t. ?f `. Phone �Qf �.. Installation will serve: Residence P -A-Partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...__ Number of bedrooms .1--- Number of baths .-Z-. Lot size..... .......r.'IS.............. Water Supply: Public system ❑ Community system Private ❑ Depthto Water Table ...... ft. Character of soil to a depth of 3 feet: Sand ❑ vel ❑ Sandy Loam lay Loam L��ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes [-] Nip New Construction: .Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public s wer is available within 200 feet) Septic : Distance from nearest well-/P Distance from foundati Tank: -----/__.`✓-------Material -_-_. .- No. of com artments- Size !� 1 r P + r ��ca��C - Liquid depth ( Capacity �rr4 Disp�o,sa�l Fi Distance from nearest well[top --_Uisfance frZSm foundaf n /P ` Distance to nearest lot line_.-..?+t..._r._ Number of lines_ ..... .... ..... Length of each line_. 0_.I_ .Width of trench.._.- -- •••. _. Depth of filter material._--. .-------Total length........ Type of filter ma eri�l_ Seepage Pit: Distance to nearest All------------------------Distance from_foundation....................Distance to nearest lot line.............. ❑ Number of pits--------------' Lining material------------------------Size Diameter----_------------------Depth--------------------------------- Cesspool: -__-----__--Cesspool: Distance from nearest well ?.........Distance from foundation -------------------Lining material_------............................ 71Size: Diameter.-- -•---- -- ---•_-----•••--.Depth...-------------------_------------------------Liquid Capacity ....... ............gals. Privy: Distance from nearest well------- ---_ -- -__- _.-_ ------- ------Distance from nearest building-_.... ................................. ❑ Distance to nearest lot line-------- -------- ------- - -------- --------------------------------..................------------- Remodeling and/or repairing (describe)------ --- ----- •------------.....................----------•---------------------•---........................................................ ------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------_-..........................--------•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan laws, and rules and regulations of the San Joaquin Local Health District. r (Sig •e* 1 r ------- _ ontractor) �. gy:--------••-•-•--•••-----•-------•-•---•--•-•--•-......-••--•-•-••----- ------ ••---- -- --(rifle)--------------- -=--- --:-- -------------- (Plot plan, showing size of lot, location of system in relati 0 wells, build' gs, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------------ -- ---•-•• --•••-•---------••......------•--• ----- DATE•------G -=-- •----- ----- REVIEWEDBY ---------------------------------- ------ --------------•----------------------- ............... DATE............. BUILDINGPERMIT ISSUED-------•------- ----------=------------------------------•-•-•---••----••-••-•-••-•----•-•--... DATE._ ................................. Alterations and/or recommendations: -------•--_-------- ---------------••---_--•-•----------•---•---•-----•---•---•--••--•---•--•-•-•--•-- -----•-_. ...-----------•-- ----- -------------------------------------------------------------- - ---•----- ------.....-_-..------------------------------------------ •-------•--- •--•-•----••--- - ----• -...--................. ------ ------------------ ------ -------------------------------------------------------------------------- ----- ------- -------- --- -- FINAL INSPECTION BY--------------- - --- _. ---- Date---------------------------��.. -----1 -- _. ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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 : Revised 1.57 EP,CO.