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5-7 2q ► C)'7 APPLICATION FOR SANITATION PERMIT Permi (Complete in Duplicate) Date S 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 with County Ordinance o. 549. JOB ADDRESS AND L�C TION .......... ��--7-.... -..AZ:�►i a__ .. .. 8 6�..--------------------------------------------------/.... .......................... Owner's Name..---•-•--_�wr!_Q.B_..--7T•a-•-• 1-=f�'%- Phone.--ir7v-� � --- --------------------------- .. . Address.................................... .............................. =-------_.....------...._......---•----------..._...... .--•--- J Contractor's Name ....... �±�.�}-.._�.....� ;�.4 ---- Phone t A rim n House Commercial Trailer Court Motel Other Installation will serve: Residence X pa e t ❑ ❑ ❑ ❑ Number of living units: __R--.- Number of bedrooms y�.. Number of baths .__/.__ Lot size _..._.7., IA.! W --0_0.r .................. Water Supply: Public system 14 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 Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ NdJ&—FHA/VA: Yes ❑ Nom( TYPE OF INSTALLATION AND SPECIFICATIONS: �\ (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) n -Se is Tank: Distance from nearest well.�,��Distance from fon �ion._.%...b .._ ..M -- .-- No. of compartments -..�.............Siz..$*...Liquid depth.-- ...�... ..-.Capacity..%D.�7. .___ sal Distance from nearest well ................. Dista, f�m foundation .................... Distance to nearest lot line................. Number of lines ................................... Length of each line .............................. Width of french ................... ......... ....... Type of filter material ................._ -___.Depth of filter material-....__.. .......-_..Total length .............................. ....... .___. ff / � Seepage Pit: Distance to nearest well._._...Distance from foundation.._.L?Q....__..Distance to nearest lot line_.. -_.e.._ 001 Number of pits. ---- I_ ........... Lining material..P�..oL' -------- . ..Size: Diameter .... 13........ Depth___.Ix------- ....... ___._ Cesspool: Distance from nearest well.................Distance from foundation.--. ...... .......... Lining material .................................. ❑ Size: Diameter -------------------------------•----- Depth ------------------------------------------------.Liquid Capacity ........................... .gals . Privy: Distance from nearest well -------------------------- .......................Distance from nearest building __-._-_-...__.__.-..-.__-_--_------__._._. nDistance to nearest lot line ----------------------------- ------- ---------- --------------------------------...... -............................... ...................... hm eling4ce r rep .. (desc 'be):- ------•--------- _-----------------x -_--•----•--• •----------.-..---- ---..-_.._.....--•--•------....................---•----- .... __'� -- --- ----------------•-------_•..-� -. �--------------------•••-- ----...--- _------. I erefy that I have p ared 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. (Signed)•--.•-..:.... �' ------------------------•------Contractor) By:.....--•--------------•--••••••-•-••......----------......-•-..!tw _- -- TJe)....._...----------•--------------- .---------------- -- (Plot plan, showing size of lot, location of systeildings, of cjran be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION APPLICATION ACCEPTED BY ------ ------------------------------------------ - •----- DATE----; r t �. %�r� REVIEWED BY...................•------------......-•-•-•--•----------_.............................................. DATE ..... ....................... i.......................... BUILDINGPERMIT ISSUED--------- ---- ------ --- -- -- ------------------------- ------------ DATE -------------------------------------------------------- Alterationsand/or recommendations: ------_----•---------- ---------------------•---------...._.-...__.-.............--•----•--...........-._............_....---------------------------- --------••---•..... •- ----..................... •...................... ------------------••--•-------- -- ----- •-- -- FINAL INSPECTION BY:... (Al Date......�..1._ 15�----------------•-------------- SAN JOAQUIN LOCAL O EALTH 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 , Revised 1-57 F.P.CO.