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APPLICATION FOR SANITATION PERMIT Permit No: (Complete in Duplicate) r ; Date Issued --------------1_4 _ 330 ZZ 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 No. 549. JOB ADDRESS AND LOCA ON - .- �..------------ - 1 -% � l Owner's Name � -------------------- -------------------------- Phone------------------------------------ ---------- Address -------------------------- ------ Address------- - �"' 4 '— �-------=''-�s� -----• ----------------•--------------- --------------------------------------•-•------------_-.--------•-•- Contractor's Name-"--. _ tiJ------- -----t = = ------------------- Phone------------------------- Installation will serve: Residence,, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: _/----- Number of bedrooms f----- � _ Number of baths _1__--- Lot size _f4-----_ ___4Z.17A1a-1t.-1 Water Supply: Public system ❑ 'Community system ❑ Frivafe,4 Depth to Water Table Character of soil.fo a depth of 3 feet: Sand ❑ Gravel I] Sandy LoamX Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nof ] New Construction: Yes r&A No E] fHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_--_"rv_____Distance from foundation__ d__�____Material________________________ ________________ No..of.compartments-- . -------------------Size--------------------------',---Liquid depth---------- --------------Capacity---gaa--------- ,C Disposal Field: Disfance from nearest well_60--------Distance from foundation___A-d---------Distance to nearest lot line-----S_-------- f Number of lines _________ ._------ Length of each line______ _________________Width of trench __ _A.-_-___._______.... M t Type of filter material _ ___-Depth of Cter material_ G__._______Totai length_________ ___________________ ___ ___ g See a e Pif: Distance to nearest well_______________ _Distance from foundation---_____.-----_---.Distance to nearest lot line________.___.__-- ❑ Number of pits---.-- _-----Lining material--------- Diameter----------- -----.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.: ____1-7,-- ----------------- ❑ Size: Diameter--------------------------------------Depth----------------------------- -------------- Liquid Capacity gals. � Privy: Distance from nearest well--------------------------- ------Distance from nearest building_-.----_----___-___-----___--.- ___.__. t ❑ ^-Distance fo nearest Sof line__________------------ ` ` --- ------------------------ emode' g nd/or repairing (doscribey:-- "�'g 'F+� °� �!`.... �z- �------- �-I! - - • _ ___________ __; _ _ _ __ --_-_____-_.----____-_-_.-__--------__-_._-_-___--.__---.--___-_-------___-_-------.-------__---_-.-_--_______._______._.______________________._...__.. ___ -__----_�____ ________ I 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.. l (Signed) -- - - -----------------------------.----------------------------------(Owner and/or Contractor By:._,� 9A- m '' l.Jrltt� ----------------------------------------------------------------(Title)-------------------- •-----•------------f (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 APPLICATIONACCEP- ED BY -----------------•---------------------------- DATE--- P --------------------------------- , a., ------•- - ` DATE---------------------------- BUILDING PERMIT --- -----------------• =---•--- -•- REVIEWED BY---------------------=��.__.�.-_ _ �_.: �--e- -=-- " ,�~`.. ------ ---------•------- DATE-------------------------------- - ----- ----------------- " - --------- - -- ----------- t - _.. ----- ______ __------ __ ____.___..-__._______ _----• ---- -- 412 e�sr Com , - �' . �2'" FINAL IN CT10N Y:.._ = v ' - -eS . -(�_- ----"�- ate �, - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sf,= Stockton, California Lodi, California Manteca, California Tracy, Calif. ES-9-2M Revised 1-57 fRCO-