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M 00 y�"► 4 Z Gk APPLICATION FOR SANITATION PERMIT Permit No. _..�. - . .. (Complete in Duplicate) Date Issued _.._A.��5Y Application is hereby made to the San Joaquin Local Health District for a_permit t construe dlns[all the weassool erein d F' i This application is made incm�plli ce with County Ordinance No. 549. .0 r'Vt3(A r — 4h ///11f�w%_�, JOB ADDRESS AND LOCATI Nk-d---.,�_M-'----'----/��...."..__�e cL�/�eY,e._� _---_-1 �C1441 ° Owner's Name_ .. 1� Q.A e--------------------......6- - AddresstT/ -------------•---------- ..__.- ._ ................ . .. Contractor's Nam .l _ ,ff. ..__.� / �..-_"_-__._------ �I! t r�sQ . -- ---E Phon �- - ,f • - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..-.__ Number of bedrooms __1.____ Number of baths _�___- Lot size -•-_17-Q_.......?_..A�r...:.......:... Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ E]Clay Loam Clay Adobe Hardpan Q Previous Application Made: Yes ❑ No VNE]w Construction: Yes No ❑ FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) � Septic Ta Distance from nearest w 1130.0_.-r-.Distance from found j�ion_1Q.f..........Material .-__ No. of compartments---/-_____ ______ ____Size __ � .?_...Liquid de,th....,�.�--------_--Capacity...__: 4___... Disposal ield: Distance from nearest well-3-0.0 __Disfance rom foundation,..%o jDistance to nearest;lot line 47 Number of lines. Length of each line. .Width of trench .�v�,.4 Type of filter m erial___ _ _____ ______ _Depth of filter material----- --_ Total length.__......46!^,---------------------- Seepage Pit: Distance to nearest well ____--------------Distance from foundation....................Distance to nearest lot line---------_-_.-_-. y ❑ Number of pits-- -- ---------------Lining material-----------------------Size: Diameter----------------------------------Depth................................. Cesspool: Distance from nearest well.................Distance from foundation--------------....-.Lining material-------------------------------------- I r_1_ __---__._ --.--__-._:__--__--- ❑_ _ Size: Diameter-_-------------------------------------.-------•--Depth----------------------------- ------------ -------_Liquid Capacity.......'..............-----9als, Privy: Distance from nearest well-_________ ______ -_ _____-. . __-_____--Distance from nearest building-----------_---_-------------------- Distance --._.-___-_---_- ______-.Distance to nearest lox1a'-'a 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 ordinances State laws, and ruI s and regulations of aTowells, Loc" o Ith District. (Signed) ,� fJ� --- --------------- '(1111" ' r Contractor) lrtle).............................By: --- ..J�4c -- -------------------- (Plot .� plan, showing size of lot, location of system in relatbuildings tc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- --------------------------------------------------- DATE-----.... .& 4-A-REVIEWED BY--------------- ------- ------------- ----- ---------------- ---------------- --------=------------ ---------- DATE------------ �---.•- --------• �--------------• BUILDING PERMIT ISSUED----------- ------- ----- ---------------------------------•-------------.................... DATE--------- Alterations and/or recommendations------------ ---------- - -------- --- - --------- -- FINAL INSPECTION BY - ----- Date_- --- &. .�.:.a? --% .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Strut Stockton, California Lbdi, California Manteca, California 'Tracy, California ES-9-2M , Revised 1.57 F.P.CO.