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1k 4 APPLICATION FOR SANITATION PERMIT Permit No. ................... (Complete in Duplicate).� 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 w County Ordinance No. 549. JOB ADDRESS AN C TION ------ --------------. � _--- _ _` 1 Owners Nam y = I f :------------- ---- •••s- ----------- ---------------------------- Phone--- . R Address r •• � '' - .. . Contractor's Name------- ------------ -------------------------- •---------------- --------------------------------- ------------------ one-•-- Ph -- �94 Installation will serve: -Residence Apartment House ❑ Commercial ❑ Trailer Court ❑eMolelOtherNumber of living units: -..a.� Number of bedrooms �'R Number of baths __:_____ Lot size _ _ _--------------------Water Supply: 'Public system ❑* Community system ❑' Private pth to Water Table ' Character of soil to a depth of 3 feet:, Sand ❑ Gravel)< Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No EK New Construction: Yes,'9, No ❑ FHA/VA: Yes ❑ No TYPE.__OF..INSTALLATION.AND SPECIFICATIONS:: -- (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) j Septi Tank: Distance from nearest well___ -Distan e .. m fo dation___:�_ .______.Materia �' ---_y� No.'of compartments---p�,_______ ________Size _ _ _____Liquid depth__ _------_--_:Capacity... ► -L!__ __�_. Disposal Field: Distance from nearest well_ ti+-._.Distance fro m foundatio ___ _ • _______-_;Distance to nearest lot line__�Q__..__. Number of lines___-__' --------_ :Length of each line-JA -_-___( .__.Width of tren_ch_.."� ►____________ ________ Type of filter mafierial_ /. _- Qepth of filter material_._.__ Total length___ 1, _� + - ----------------------- Seepage Pit: Distance to nearest"well_._y' _____________Distance' from foundation___-W____:..._.__:Distaiice to nearest lot line_'___..___.____ ❑ N umber of pits- -- {--------------Lining material-----------------------Size: Diameter--_----------------------Depth---------.-.--------------__----- Cesspool: Distance from nearest,well_-_-------------Distance from foundation-------------- material----_-_____________r__._a______-_ ❑ Size: Diameter---------------------- _----------Depth---------------------------------------------_------Liquid Capacity----------------------------gals. Priv Distance-from t : _ y;._.>,. :r,rw j-'rA, :°v r �_ -. ._ ..�� .- .. .t -- - .s: - - y' 'nearest well----------'_-.-5--------------------------------Distance from nearest building------------------------- El Distance to nearest lot line---_____ ---------___ _______- -- - --- -_-• i' a --------------------------------------=-----------=--------------------------- Remodeli and/or repairin F (describel:--- -------- -------------�t _9 __._-- `f Z------- ----------•- ---------------------- y a :�' ---------------------------------------------------------= — ----•-- ----------------------------------------------•-----------------------------------•-_••_--'----=---------••-----•---•--••-----------------------p --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ite lawg, and rules and regulations of the n Joaquin Local Health Disfric {Signed)- - ! r ,i ' w _j,%01 ..;, r ` (Owner and/or,Contractor) Y: = ... - •---------------------- a le] f (Plot plan, showing size of lot, location of syst m n.relation to wells, buildings,ketc.;'can b`e'placec! on reverse side). FOR DEPARTMENT USE ONLY-- APPLICATION ACCEPTED BY------ ----- '' DATE REVIEWED BY_ _ ._ -_---' --- ` DATE--_.-:- r.• ----------- ----I BUILDING PERMIT ISSUED--------------- '4 DATE----------------,_----- - -- -- ---- --- -------------�---- - - ----------- ----------------------- �. ----------------------------------------- --•-.--- Alterations and/or,recommendations:------------------ --------------------- --------•-------- -••------------- , y ------------------•--------- ------------- -- ------------- ------ ------------------------------------------------------------•-------...._..-----------•---------•----••--------- 0 ----------------------------------`------------------ I ----- -- "----------r--"--'------••-- --- ------- ---- FINAL INSPECTION BY::--n Date--- -- -- — —': 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 . Revisea 1-57 F.P.CO.