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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �/� 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 applicatiori is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION--- ---- ? +� �+1►7_ems----WaX--------St_0_CktQa,-- Q;0_ for-n a Owner's Name----------------Pauline-- Bi$IQs-------------I----------------•-- ------------------- -----------------------------------------. Phone Address..----------•----•---235-__E..-.Knoj - - -__Waw` StQ ktron �� lfnrn a _ ------------------------------------------------------- n t + _ Contractor's Name---------"S+ `+ �BT iS l-=&__awis :z �'� Phone © __6� --------------------- 9------7------ Installation will serve: Residence Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i i Number of living units: _-2 Number of bedrooms --3-- Number of baths --_2- Lot size --_--- Q_--_ __10-0! Water Supply: Public system EX Community system ❑ [Private ❑ Depth to Water Table- -'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No & New Construction: Yes ❑ No-*] FHA/VA: Yes ❑ No Ek TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer:is available within 200 feet.) Septic Tank: Distance from - nearest well ------'---Distance from.foundation--------------------Material------.---_---_------_-_----. - E�.stimg No. of compartments _- ------- ----- -----------$ize. = --_------- - p-.-Liquid depth----------_-- Ca acit Y Disposal Field; Distance from nearest well--------------- Distance from foundation----.---------------Distance to nearest lot line__--__---___---_. ExPat in Number P ben of lines----'----- I------------------- -Length of each line------------------------77 Width of trench-------------------- ------------- T e of filter maferial----------""'"`"'"""`""----Dept'.of filter material-----------------�-Total length------------------------------------------ Seepage Pit: Distance to nearest well--.XpZek______Disfance,from foundation------10-----.Distance to nearest lot line---- ------ Number of its---_1 ---------------Linin material-_- R D_C.k i� f pg Size: Diameter - Depth �J�------------------ Cesspool: Distance from nearest well--_,---------__-Distance from foundation-----, ----------..Lining material---------- --- ----- Privy: Distance from nearest well---------------�---- -----------------�-------- - - ---------------- -- - - -c Liquid Capacity------------------- gals. ❑ Size: Diameter------ _-.-_- ------------ Depth '-Distance from nearest❑ building----------- ---- ----------- Distance to nearestllot line---------------- ' ti 11 Remodeling and/or repairing (describe): -"Install_=-""��..--_ a.slliflp _ 5'__de!* Roekfilled ----------------------��t�r�ec tm einP♦----- ----•--- ---------------------------------------------- -------------------------------------------------------•-------------------------------------------•----------------------------------------------------------------- I hereby certify that I have prepared this applications 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)---------------------D:A-•- Parr1A --- ---'S---® $...Inc � - (Owner and/or Contractor) BY .a.. -i$$t---------------------------------------------------------------------------------(Title)----------------EirtAlRe t or--------------------- I --------------- 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---------------------- DATE------ ___•__.,_.__________ ------ ---------------------------------------------------------- - --------------------------- REVIEWED BY `----------- DATE ---- _"!t- BUILDING PERMIT ISSUED--------- J--------------------------------------- Alterations and/or recornmendat ons:---<--- -- A ------------- -------------------------------- ` ��------ ---------------- ---- -- - - - a _� ----A---- --------•-- --------- --------G--- ------------------------------------------ __---- FINAL INSPECTION BY:..---- = -------------- ------ Date----- -'. '' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.