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76�s� PERMIT Permit No. . -- � -- APPLICATION FOR SANITATION in Duplicate) ` U (Complete P } Date Issued ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and all the work herein described. This application.is made,-in compliance with County Ordinance No. 549. JOB ADDRESS-AN¢ CATION:-- L �I ------L%f '0.14------ ``lJ .�- --- Phone---- Owner's Name-------- ` C C 'R� -------- Address ) ll-s 8 =- — ----------------�� i ------------------------------------------------•---•----- .0 --. -----�---------------------------- Phone Contractor's Name-____-- � �------ ----'=��+�,!<S--/-y------�--- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ -- -----------------•- Nurrnber of living units: __._____ Number of bedrooms __�-_�Number of bats -------- Lot size ______f�----C�-��- Water Supply: Public,system ❑ Community system ❑ Privat�VyqL Depth to Water Table _ __ ft. Sanam ClaLoam ❑ Clay ❑ Adobe ❑ Hardpan [�Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ y Previous Application Made: Yes ❑ No ElNew Construction: Yes " ❑ FHA/VA: Ye Na ` TYPE OF INSTALLATION,AND SPECIFICATIONS: No se tic tank or cesspool permitted if public sewer is available within 200 feet.) ( 1 I� P l �Septi Tank: Distance from nearest we __�v_ Distance from foundation_" ___._-_.Matai_�_ _ _ .7�'___. Li uid de th-___ _"�_____-.____Ca acit No. of compartments------ Size _ q P(, P Y' 4 Distance to nearest lot ii . 1.Dispos I Field: Distance from nearest well_ "_=___.Distance from foundation_ j,. ___-.Number of Li�aes-------/------------------- --Length of each line------ y-----Width of trench . -- ----De th'of filter material__.- _`_�:"_.--"Total length____.--_.�_�----Type of filter material__"" - . 1` P / - Seepage-Pit: Distance to nearest well--_-_-7_7__._-_'Distance from foundation___."______________Distance to nearest lot lineNumber of pits---------------------Lining material----------------------Size: Diameter---------------- ------DepthCesspool: Distance from nearest well_--_-__k�____:_Distance from foundation_____________________Lining material___"__.-__-__ _-Size: Diameter------ ----- ------- -----------Depth"-_----------------------------- -----------------Liquid Capacity------------------ Privy: Distance from nearest well_---------.--------------------------------------Distance ---------------- ------Distance from nearest building---------------------------_-------_---- ❑ Distance to nearest lot-line.----- ----- --------"-----------=- ---------- •------------------------------ 4 - t h Remodeling and/or repairing (describe)-------------------------- •-----"----------------------•----•P ------•--------- ---------------------- --------------•-------•--------------- -. -:--- , -----------------------------------------•--------------- ---===----- ----------------------------•------------------------------------------------ •---•---------------- I hereby certify that I ha prepared this a is ion and that the work will be done in accordance with San Joaquin Count ordinances, State laws, an es a regulati s the San Joa uin Local Health District. \` (Signed) -- • . - ----------- -------------"" -- (Owner and/or CQ trl�acto By:---------------------- ---•-----------.-_----------------------=--- ---- ----------------------------------{Title) (Plot plan,.showing size of lot, location of system in relation t its, buildings, etc., can be placed on reverse side). �P.�,RRTMENT 5E ONLYAPPLICATION ACCEPTED BY----- -- -- �---- --- --- ---------- DATEREVIEWED BY - ' DATE----r--r---------------------------------------------------- ------------- ---------------------- - ----------- ----------------- BUILDING PERMIT ISSUED------------------------------------- --------•------------------ DATE Alterations and/or recommendations--------- -------------------•----------------------------••--------------•-------•-------•----._...-----..-------------•---•--•-------•--- ' -----------"--•-----------•----•------------"---------- ---------•-------- -------- ------ ----------- -- -- ---- -- - - ------ -- - --------- - - - " - -------------------- Date_ ----------- ------------ _. .. -.. FINAL INSPECTION BY:..---- -: _ -- --------------I---------------- ! 7---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.GO.