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I v! d S 7 APPLICATION FOR SANITATION PERMIT Permit No. --------- (Complete in Duplicate) Date issued V-s- J5--g._____ 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 incompliance with County Ordinance No. 549. r JOB ADDRESS AND LOC TION---kc-�,os �r,� �- -- ---�------�__V------ ,`- --- -- - ------------- Owner's Name -- F.•-........A----------- ------------- ----------------------------------------- Address -- - -- ----Address t i`' } -----. �______________ .___---__..__________.._________________.____________________.__.-_.4_________._-__._________{..___._____________._.-_.___________. v• Contractor's Name-----------------------•-- t -------------------------------------------------`------------------------ Phone----•----------------------------. r Installation will serve: Residence Apartment House ❑ Lommqrgal ❑ Trailer Gourt ❑ Motel ❑ Other ❑.Number of living units: Number of bedrooms _-Z_ mbe of baths -------- Lot size _�_ ______________________.___ Wafter Supply: Public system ®--tommunity system ❑ Private ❑ Depth to Water TableA_'_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . 3 . , (No septic tank�Ior'cesspool permitted if public sewer is available within 200 feet.)1 d Material--- ------------• _ Septic Tank: Distance from nearest well__ t n� ce f6srh �i�{id 4on__.�- ________ _. No. of compartments__�---------.. � "� % -Li juid depth------- j------------Capacity....1 --•-- mow. f" Disposal Field: Distance from nearest well.-1-4)-`L-__Distance from foun ation_1J0___________Distance to nearest lot line___ .---___-- Number of lines--------OLA-- --- ----------Length of each line___ _ R•O Width of french----:Z.lif _._ Type of filter material--- _______Depth of filter material-- -/do-------------Total length( __----_-- Seep.a Pit: Distance to nearest well�l+`-h+'-*w.____-_Distance' from foundation----fb----------:Distance to nearest lot line_.-._�3--- Number.of its____ Linin material___.__ ,reek____-Size: Diameter_____ ___________ P g Depi It&------------------- / Cesspool: pis anceefrom nearest well-----------------Distance from foundation__k-_____.______.Lining material----------------------------- 1 El Size''Oiameter------------------------------.--"'---Depth--'------------. :-----_----- - --------------Liquid Capacity----------------------------gals. Q .�Krt. Privy: Distance from nearest well------------_---------------------------------------Distance from nearest building--------------------------------------- oC? D'sfance,to nearest lot line____________________. ' Z7 Remodelingand/or repairing (describe):--------------------- ----------------------------------------------------`-------------------- -------------------------------------------------------- ---------------------------------------------------------------------------•--•-- -------------------------•------------------------------------------------------------------------------------------------------------------ I l ------------------------------------------------------------------------------•-------------------------------------------------------------------•---------- = --------------------- ----- 7---------------- -------------------- ------------------------------------------------------------------ •------------------------------------------------------------------------- ----------•---------------------------- ! hereby certify that ( Have prepared this application and that the ork will be done in accordance with San Joaquin County ordinances, State laws° and rules and regu;ations of.the an Joaquin o altH th •strict, t Si ned /� l ( g �/�' r ("(j ----- --- (Owner and/or Contractors /' By ---- ----------------------------•------------------------------------------------------ -----=---------"--------------------(Title)------------------- --------------------------------------- --- (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 C?/- ------------------------- REVIEWEDIBY_!��----------------------------- -------------------- ------------------------------------------------------------------- DATE -----------------•------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ------------------ DATE------------------------- ----------------------------------- Alteratecommen ati ns-------- -------- --.--.--------------------•-----•------------- ------------ .%1 ----- �------�------ r `- ---- ;LnW 4 X3 .e - --- --v---------------------------------------------------------------- -- --- --------------------------------------------- ,,. ._ - --- -- - I----- -------------------- -------------------------------------------------- --- ------------------------------------------------- FINAL INSPECTION BY:--- -- __--- ---- bate_- _- 4_4-------------------------------------- . --e----, - -- - -- -- --- - -- _-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisers 1.57 F.P,CO.