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I APPLICATION FOR SANITATION PERMIT Permit No. A2__71_7_ t (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 with County Ordinance/No. 549. f JOB ADDRESS AND LOCATION........ -A------ __J1J�a ---------------------------- - ---- ,/ - Q_i_1 d------ �,�4 !_!I�p--------------- ------------------------- ---- - ---------------x�---- ----------- - Phone--------------- ------------------ Owner's Name_________ - Address__-------------- � � .. i!!:_ _2i -------------------------- --------•------------=--•------•----------------------••------- �- Contractor's Name-------------- ��' ��--••- 1 - -- 5"-`- -- ---------------------------- - -------------- Phone--- ate Installation will serve: . Residence 0 Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ tL_ Number of living un'sts: . .__ Number of bedrooms _- __ Number of baths __-- Lot size __ _.-_ _______._-.-------------- ' .. Water Supply: Public system 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 0 No4 New Construction:. Yes ❑ Nak FHA/VA: Yes ❑ N.5 r I TYPE OF INSTALLATION AND SPECIFICATIONS: '' 11 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' w e Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------------____. No. of compartments---- --------------------Size---- -----------------------Liquid depth--------------------------Capacity--------------------- If Di�osal iel". Distance from nearest well_. f[v�_ =Distance from foundation__1��.-____.Distance to nearest lot line_Jei.________ ` __.______Length.of each line______c�]:V_____________ Width of trench-------- �__._____-_____._ 1 lumber of ]ines______-_�__. err r p s �� -- -- -�` p - - �f_.Distance�go nearest lot line... __� r � e filter material _ __-Depth of filter matenai___f�______.___Total len th_____ _____________._____ SeeWe e Pit: Distance to nearest. well____ iQ—4c___Distence rom foundation_._._ r peptn____-�_2_. _/�_._...__ . N.�m��r of pits._-------------Lining materiaL__��----C_te__ _ Size: Diameter___ r Cesspool: Distance'from"nearest well________________Distance from foundation--------------------Lining material-__-.._____..___..____.-.__--_--.- ❑ Size: Diameter---------I—----------------------- Depth--------------------------------=------------- ----Liquid Capacity_--------------------------gals. Privy: Distance from nearest well----------------_--------------------------------Distance from nearest building--- ____.__________________ _________. j ❑ Distance-to nearest lot line___-------------------------- - -' - + --------------- � .� --- _ -- Remodeling and/or repairing (describe):______ — ----------- --- - -----------------------------------------------------------j r -------------------------------------------------------------------------------- I hereby certify that I have prepared this.application and that the work will-be done in accordance with San Joaquin Counfyi ordinances, State laws, andles and regulations of the San Joaquin Locai Health District. (SignedR � -- ------- -''------- ------------------- Owner and/or Contractor) --------- ..- ---------------------------------- Tit Plot plan, showing size of lot, location of system in relation f " ells, buildings, etc., can bee) `yam �--` � p g y placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------------- - DATE---- -------------------------� REVIEWEDBY------- ------------------=------`----------- ------------------------------------------------------------------------------ DATE----------------------------------------------------- BUILDING PERMIT ISSUED--=--._--------------------------------- -----. DATE I �ilr -------- --A-f--s-' W- Alterations and/or recommendations`------------------------------------------------------------------- `--x--�_-- �� . -----------------------------•-------------------------•------------------- --------=----------------------•1-------- "�- ---- --------------------------------------------------•----- -- ----------•---------------------------------------7------------------ , FINALINSPECTIOI � BY:-------------'------ = =------------------- ==------- - Date---------_---------------------__.:.:_. _r---------------•------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 North "C" S+ree++y Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M , Revisep 1-57 F.r,CO.