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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ermit No. _�__ ---- Date Issued ____ -d; -s--fes----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo erein described. This application is made in compliance' with County Ordinance No. 549.. ------------------------------------------ JOB ADDRESS AND CATIO __ ___________ _' Phone ------------------------------------ Owner's ---------- --------------------Owner s Name_--------- -an e------- ----------------- -- Address- ewz--------` +r "- > '�+ .� Contractor's Name____________ __ . --- ------------------------------------------------ Phone. 0 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ s -- i Number of living units: __/___ Number of bedrooms Number of baths _/--- Lot size Water Supply: Public system ❑ Commun'ity system El Private El Depth to Water Table ft. Adobe Hardpan Character of soil to a depth of 3 fee Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ � ❑ Previous Application Made: Yes ❑ ' INo U?" New Construction: Yes V?0*`No ❑ FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 0 (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) / ► _AP---------Matrial �-�.� —40.101Z ----- Septic Tank: Distance. from nearest wee�ll___.��____ Distance f m foundation__. _- �/ No. of compartments Size f±__-.- 'q Liqusd def?ih �", Capac�tY 4 Ar -6 ----------- Distance to nearest to line___,--___- Disposal Field: Distance from nearest well___._`a''----_Distance from foun atio ------- �---------- �L si ,ter Number of lines- ------------- j ----- ------ ngth of each line ------- ---------�I Width of trench-- -------------------- la' �+ ------------------------ jrType of fii#er material_/ epth of filter material_--��A_---------Total length______-3'l�%-- i -�-, Seepage Pit: Distance to nearesljwell--------- f £ou tion__ ___ D t nice to nearest to li U,I Number of its._, Lining material ___-_- ze: Diameter____ --.-----Depth_-_ ---- P Cesspool: Distance from nearest wellDistant oundation__..---------------- Lining material ------------------------------------ --- F1Size: Diameter-------------------------------------Depth----•--------------------------------- ------------ Liquid Capacity g Privy: Distance from nearest well ----------------------------------------------- ---------------------------Distance from nearest building ---------- -------------------------------- ❑ Distance to nearest lot line ----------------------------------------------- --------------------------------------•------------------- ----------------------------------- Y1__ �s'- Remodeling and/or repairing Idescr'sbe)-------------------- -------------------------- ------------------------ ------------------------- ------------------------ --------- -------------------------------------------------- ------------_------- ._- •-- ---- --- ----- ! 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. r ---(tor Contractor) ----- -- 06 _•- %— -------------- (Signed)----------- --------------------------------- ----- - � ------ ---------------------- -_---- (Plot plan, showing size of lot, lot n of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY '�, APPLICATIONACCEPTED BY------'- ----------- ----- -- ---- �------•--------------------------------------- DATE_ ----------- ----------- ► _�--------------------------- REVIEWED BY--------------------------------------------------------- - -------------------------------------------------------- DATE ------- -j---- ----------------- ----------------------- BUILDING PERMIT ISSUED------------------------ ------------------------------------- -- --------------- DATE -------- •--------------------- -------------------- - Alterations and/or recommendations: ----------------------- --------------------- ------ -------------------------- -------------•--------------------------- ----- ----•----------- ----------- I ---------------------------------------------------- -------------------------------------------------- I --- ------------------------ i -----------•-------- --------- FINAL INSPECTION BY:.-----��'"------------- Date-------- ��------------------------------------------- 130 Sou+h American Street Stock+on, California- f ES -9-2M Revised 1-57 F.P.CO. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wesf Oak Sfree+ + 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Street Tracy, California