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nnoo-7 1<e 5;4cv�e, A APPLICATION FOR SANITATION PERMIT Permit No. _!' Q (Complete in Duplicate) <5� ' Date Issued .... —------- 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 Ordin nce N&�- 549 "]-^ JOB ADDRESS A D ION --- ------- - _ z` "'. .-•---- ..............t..c�__-.�_. ._.. " Owner's NZ e!ce--2Q-------------- ------------------- Phone--•-•• •----------••--- Address —---- ---------------------!2* .....................................-.-............I....... .......... � Contractor's Name //�10�-T Phone lsl �T 66. Installation will se Residence Apartment House E] Commercial E Traill r Court El Motel [I Other ❑ Number of living units: ._!-_.__ Number of bedrooms - __ Number of baths --_-_ Lot size ....48-..__!�.__„lP----------------------- Water Supply: Public system ❑ Community syst m Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Cl Adob�, Hardp Previous Application Made: Yes ❑ NdNew Construction: 1@3 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se ti ank: Distance from nearest well_-� ----•Distance from foundation.l' x Material - %� -�`' . ... No. of compartments---Z---•-- -------Size - !hd-U-'----Liquid depth- �� Ca acit ..,� n P Y - - Dis o al Field: Distance from nearest w I _Q_Q------Dlistance from foundation.10------------Distance to nearest lot line.,... . Number of line Length of each I PSIM"-! Width of trench Type of filter material__-- --Glu ---Depth of filter material----1 * ______._.Total length......... p -4... Seepage Pit: Distance to nearest well-------------_--------Distance from foundation....................Distance to nearest lot line..........._•_-_ ❑ Number of pits_____________________Lining material-----------------------Size: Diameter_____------------------------Depth--------------..........___...... Cesspool Distance from ne'grest well--------------._Distance from foundation___:_._______________Lining material - __:....._ _..,_....� ❑ Size: Diameter =----Depth---- -- ----- ------- ---------' ------Liquid Capacity --•----- _...---..._..gals. Privy: Distance from nearest well-------------•-----------------------------------Distance from nearest building------------------------------------------ 171 ____ _________ ____._______-__.❑ Distance to nearest lot line--------------------------------- -------- It-- ---- ----- --------------------------------------- Remodeling and/or repairing (describe):---- ------ - -•--- a'' - •••- • ^� - -----------------------------?---- ----------------------------------------------•---------------------=----------------------------------------•---------------•-........................-----•-----------------------•-•-----------------------•-•---•--...._ ------------------------------------------------- ----------------------------------------------------------------------- ---------------------------------------------------------•-------------------•------------------ I hereby certify that I have prepared this application and that a work.will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the S Joa in Local Health District. DAY$ NIGHT (Signed) --- -------------- -- ........................................... fi+ Contracto -- SRptic-T�rnk-�rv?fb-- --------- - ' By:---- _._ _HS?.$-7A911 - - •----•--(Title) (Plot plan, showing size of lot, I8ZTW8W%f in rel n to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---------- ---- --------------•----------__ DATES REVIEWEDBY------------------------------------------------------------------ --------------------------------------------------- DATE---.................................. BUILDING PERMIT ISSUED-------------------------------------------------------- -----_-------------------------------------- DATE........................ ........ Alterations and/or recommendations:--- --- ---------• •----•-- ---••----.-•--------- •••------•••......---•-•-•------- -•••----•----•---------.................................. 1:::;FINAL INSPECTION BY-------- ---- --------- ----- Date------ - - ................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8147rth "C" Street Stockton, California Lgdi, California Manteca, California Tracy, California \' ES-9-2M . Revised 1.57 EP.CO.