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APPLICATION FOR SANITATION PERMIT Permit No. ,/d--- -t (Complete in Duplicate) o/ Date Issued F 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 LOCATION------ L ----- yr/Ify � - _/ OwnersName---------� 1 C1(_ a -------------------------------------------------- -------------------------------- - Phone--------------------•--------------- Address----------..V / Contractor's Name , x- ----- Lo--t----------------------------- ---------------- Phone Installation will serve: Residence P;�' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living-wits: - -1- Number of bedrooms ------f Number of baths I--- Lot size ----- 1 Water Supply. Public,system [N Community system ❑ Private & Depth to Water Table ---.--:- ft. Wk.pj _ � u Character of-soil to a depf 3 feet: Sand E] Gravel [] Sandy-Loam 0 --Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction:Yi3-s`91 No ❑ FHA/VA:Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public ewer is available within 200 feet.) f Septic Tank: Distance from nearest well-.-.f ----_Distance from �Oundation------/X_ _.Mate1r'al_--_ ,D_l�lr ¢ f]_Q_- -___- ® No. of compartments____-..-�---------Size_-- X-,S'-x-�-- Liquid depth_- 5 _____________Capacity- ,C -c�-D- -.g,9. r - - ; l Disposal Field: Distance from nearest weli__ �. Distance from foundation__ - -----.Distance to nearest lot line_- --_--y_. © Number of lines----------------1-. _.----------Length of each line----__---44-r_-_____---.Width of trench------� ---------------- Type ��______--------- V,1 $�UK®epac�c-fit: Distance nearest well from foundation--_� f� Total length-__-_-----�________________________ 0 T e or filter material___-_--D�eG.----De th of filter material__-.-- � `� f -..Y-.-..Djs�an e to nearest lot ne�_- �t] Number'of pits----- -- ------•=L-inirg material---" ---- Size:;Diameter---------X-----------.Qepth--.-------67-------------------- Cesspooi: Distance'from-nearest-well-----------------Distance from foundation--------------.-----Lining material---___---._------------------------ ❑ Size: Qiameter' - `= --`----------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals.- Privy: Distance from nearest well-.' -----------------------------Distance from nearest building-------------------_----__--__________--- ❑ Distance t0 line nearest l`ot Remoing and/or repairing (describe}:-.---- de'C[e----- i9Nt ---f.-----l�r_4r_fi0Eff.Z.---%jVkjT��----SM---� Ply------------fes 0 � ------------------------------------------------------------------------------------------------------------------------------------------------ -----� ----------------------- ------------------------------------------•=-------------•------------=---------------------------------------------------------------------------------------- ---------------------------------- - -- 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. (Signed)..,-.. ��p �1 `_ ----------------------- ------- ---- -----------.(Owner and/or Contractor) i 13y:. C ----------{Title)----------O�`'--'-'`��.--------------------- --- (Plot plan, showing size of lot, location of system in relation to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------- --- i-- --------------------------------------- DATE--------- a REVIEWEDBY---------------------------------------------- --- ----------------------------------------------------------- DATE--------i-�--L7-"_-_----------------------------- - BUILDING PERMIT ISSUED -- --------------------------------------------------------------------• DATE ` Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- --------------------------•------------------------------•---------------------------------- ------------------------------------------------------------------------------------- ^ ---------- !_'- ------------------ ------ -- --------------------- " F ------ _ ----- ----------------- s - t -- -- ---------- ------ b HNAL ;e ? ' FINAL INSPECTION $Y-------------------------------------------------------------- - Date------------------------------ -- ------------- ----------- ------------- ft SAN JOAQUIN LOCAL HEALTH DISTRICT a 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 ES-9-2M Revised 1-57 F.P.CO.