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4 APPLICATION FOR SANITATION PERMIT Permit No. ...11..7 . (Complete in Duplicate) Date Issued This Permit Expires 1 Year From 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 application is made in compliance withCQ,ly Ordipance No. 549. i JOB ADDRESS AND LOCATION�5__ _ _ ........ -------- Owner's Name-------------- /& e---------------------------------------------------------------------- Phone- Address- ne Address. (/ = .. -----------------------_--•--------------------------------------------•----------------------- t Contractor's Name----------------- ----------- ------ -� ---------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai r Court ❑ Motel ❑ Other ❑ Number of living units: _-____ Number of bedrooms _ ._ Number of bath/______ Lot size ------- C1------x__._.,l__ _ -- - --._ Water Supply: Public system ❑ Community system ❑ l Private [X• Depth to Water Table _elft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ —� Previous Application Made: Yes ❑ No X New Construction: Yes !a No ❑ FHA/VA: Yes ❑ No�g. TYPE OF INSTALLATION AND SPECIFICATIONS: 1'i (No septic tank or cesspool permitted if public sewer s available.within 200 feet.) Septic Tank: Distance frorn"nea'rest well_____'.- -_Distance [ Di ltanc e from/ound�ion____ZQ_______.Material----- ---------- No. ____ -_-____No. of compartments---_---.___�____ ____SizyLiquid depth-------- _ _ C?a 2_acit_ l� f`.__ istance to nearest lot / Disposal Field: Distance from nearest well-_S6?____Di I ante from foun � n._cfC)ye_____ KNumber of lines-------------__._______ Length of each linefL__ -Width of french--------.;._----__ ________.___ .� Type of filter material__-r.-tt...e ____Depth of filter material_- /F------------ length--------- Seepage ________ See a e Pit: Distance to nearest Well-_/0 d-- /Distance fro f ndation____._ _ _ a " �S_.__,Distance to nearest lot line____-�._____ h� p g Number of pits-- - -- `-- --'Linin mat tial.____-W Size: Diameter__:_�,1_.r:_..__-_Depth-.------------------------------- 1j: -a�------------- ii. Cesspool: Distance from nearest weil_________________Distance from foundation__________._---____ Lining material__.__._.__.-__________.___._______._ ' f❑ � Size: Diameter -------------- ---------- be``pth------------- ------ ------------------ - ------Liquir� Capacity ------------------------gals. Privy: Distance from nearest well_____________________li--------------------------Distance from nearest building---_.__________-____________..._-_-----_. ❑ Distance.to nearest lot line------------------- I----------------------- ------------------------- --------------------------------------------------------------------- { Remodelingand/or repairing (describp)---------------------------- -•-------------------•--•---------------------------------------•--- -------------•------------------------------------------ H • ------------------- ;, !� --------------------------------- ---------- I -------------------•----------------------------------- --- -------- I hereby certify that 1 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. E - (Owner nd/ Contrectorl (Signed}----__- ` Tale k (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--_-3_`_�__47 --lQ--j------------- ----- -------l-------------------------------------------------- DATE------ ----------------I----- ---- - - REVIEWED BY--------• -------- - - • - --------------- ` BUILDING PERMIT ISSUED-------------------------------------- -------------- --------—-------------------------------------- DATE--------------------------- tAlterations and/or recommendations:--------------- -------------------- =----- - ---------------------------------------•---------------•----------------------------------------------------- �------------------------------ -------- --- ------------------------------------------ / --- --- Q i ---- - --------------------------------------------- ----------------------------------------------------- -- ---- - --- e----- E --- ------------ FINAL INSPECTION BY.. I '~a -9= (� ----- - -- -- -- ---- --•----.i--------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cafifarnia Lodi, California Manteca, California "' Tracy, California t ; ES-4-2N1 F.P.Cu. \