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Permit No. 3�_V__ lt . APPLICATION FOR SANITATION PERMIT J1s (Complete in Duplicate) --�/ ` bate Issued _______!` .7__-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w k herein described. i This application is made in compliance with County Ordinance No. 549. ---------- 9;/, ------------ JOB ADDRESS AND LO TION---___-- - f -- .,---�'`- -- -- a�..-'� "'`�---- -... ------ ------- ---------------- P ho �__.ic__i 1.7 Owner's Name------------ ----- Address---------------- 2.c �— 4._'G`r ------------- -----------------------•--------------- ---------------` -- Phone-- - --- --�-�------ Contractor's Name-------- ----� --------- J r Installation will serve: Residence Apartment House E] Commercial E] Trailer iCourt [I Motel ❑ Other Number of living units: ________ Number of bedrooms -------- �__Number of baths _ Lot size -----d � Water Supply: Public system ©fCommunity system El Private F-1Depthto 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 F1No F-1New Construction: Yes E] No ElFHA/VA: Yes ❑ No ❑ �y F 1 TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted.if public sewer is available within 200 feet.] Distance from nearest well-________________Distance from foundation____._____-,__.___Materia!-___.______-.______._.___________.____________. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------- --------- osa�Rel Distance from nearest well___ ___________Distance from foundation-----------.--------Distance to nearest lot line------.-._______- Number of lines-------------------------- --------Length of each line------------------------------Width of trench---------------------------------.- "' Type of filter material-------------------------Depth of filter material---------``------------Total length------------------------------------------ See age Pit: Distance to nearest well__ �7 _____--Distance om undat•o _ _!__ ___ r__.Di e to nearest I line_._ �� ff n Depth_.. Number of pits-----1- -------------I-fining ma#e.rfal--- ---- ---- - -S�e��'� -- �- - -- --- ------ Cesspool: Distance from nearest well__----._________DInee rOM ovnda it-b d_ --_Lining material_____________________________________ Size: Diameter.--------- -------------------Depth------•------------------- �-r--------------------Liquid Capacity_.... --------------------gals. { Privy: Distance Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------.-------------- ❑ Distance to nearest lot line- --- Remodeling and/or fepairing (describe):-------- -- - 'r -t---- --41- - -- ---- �� •_ , ,. , f ---------------- -------------------------------- X. ------------------------------- YQ ------------ ----------------------------------------------------------------- -------- ---------------------------------- -- I hereby cer 'fy at I have pre red this lication and tat the work ' 6e done in accordance with San Joaquin County ordinances, State �ws, and ruN an regulatio f the San J a uin ocal a th District. (Signed)--- rced� tract ••------------------------------------------ ------ {Title} r on------------- By:(Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., an be preverse side). FOR DEPART USE ONLY APPLICATION ACCEPTED BY------------------- =y:: ---------------------------------------- DATE _ �/ LI REVIEWEDBY------------------------------------------------ ;- �^-- DATE ----------------7-------- DATE --------------- - BUILDING PERMIT' ISSUED--------------------------- - - ------------------- DATE---------- ---------- tions and/or recommendations: ------------------------------------------------------- 4A f1' .__ --------------------------------- J 7 c� w. � _ -r f = ..� I �i f ,,,r��`rv'""'------ -�-�-u- = --- ---- --- --- - - - -G-e,,•-rte- - FINAL INSPECTION BY:-----4-- ------------ Date 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M Revised 1-57 F.P.CO.