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Permit __f_-_ �-��-•-- IIV APPLICATION FOR SANITATION PERMIT No A < (Complete in Duplicate) Date Issued r!---I�_ t made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. ' Application is hereby q This application is made in compliance with County Ordinance No. 549. 4 , a�i�►.t.vi2� � r �/ JOB ADDRESS AND LOCATION: �7`�,3.3 , � �i✓. 5 --- Cf _!?_ " Owner's Name = = f�_eZ.,f..S'1-----------------•------------------------- ------------------------- ---------.-- Phone 4.__- 7 . { c ------ - --- ' ' Address---------•---------��`��.33 ,� ----- t,?__ _. ..:__ �� -----•--- Phona- - ---- ./s .. i Contractor's Name_____:____ � .. 'l�` Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court F1 Motel ❑ Other ❑ Number of baths. / Lot size .------f �"� ---------------------------- i Number of living units: _/--I- Number of bedrooms _.� , Water Supply: Public system ❑' Community system" El LW Depth to Water Table .____�:_ ft." 1 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 ElNo FHA/VA: Yes ❑ No . TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or'-cesspool permitted if public sewer is available within 200 feet.) .. Size -Li uid {th_- e I" 1 .. ---------- Septic Tank: Distance from nearest welL__��_Distance frof foundat�on_,.� acit ----------------- on-1--24 '��----- i � No. of compartments_____.__ . -s------ -- q p Capacity ------- - /y `L■ Disposal Field: Distance from nearest well---.!N--__---Distance from foundation_ . ��__..Distance to nearest lot Number of lines---------__I- ------------------Length of each line-----�.i-----___lie------Width of trench--= S ------•------------ Type of filter material____ />C _ ---Depth of filter material-----:IF.--------Total length------Vi J Seepage Pit: Distance to nearest well---_J'LC ___________Distance -,�•� ---_---- 'Distance to nearest lot r Number of pits.-----/--------------L*inirig m4' _ _Size: i meter__. � De th__.oV-s� ------- ---------- �Ik --- --- rom ound�__......--- :Lining material-------------------------------------Cesspool: Distance frorh nearest wel!__,____ gals❑ Size: Diameter------------------------------------- ------.Liquid Capacity------------------------ Privy: Distnnce from nearest well------------------------------------------------Distance from nearest building-------------------------------------- ❑ Distance #o nearest lot line ---------------------------------------------------------------- Remodeling and/or repairing (d6scribe)----------------------- - ----------- ----•-• -------•-------•------------- I l ----------- •-------------------------- r ` -=----------- ----------------•----•------------------------------ R : hereby r -•-------�=-•----•---------•-=---------------------•------------- --------------------------------------- ., application and that the work will be done in accordance with-San Joaquin County ordinances, Scertify that Ihave- eared this tate law , nd rules and regulations of the San Joaquin Local Health District. {Signed}-------------- -• -- -'------- -----= ------------------(Owner and/or Contractor) - --(Title)-- � ---------------- (Plot plan, showing size of lot, location of sy m in relation to wells, "buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________ _ __ _ ___ _ ____ __ DATE ;rF - ------------------------ REVIEWED BY = :. DATE --�---------------------------- x BUILDING PERMIT ISSUED------------------------- -- -- - ------------- DATE- Alterations and/or recommendations: } --- ----------------------------------------- ---------------- ------------------------------------------------------------------- � P-� � � �---------- -- - -- -- --- ---- f ------------------------------------------ --------------- ------------------------------ ------------ ------------------------------------------ ---------•-------------------------------•------------------ 1� l� FINAL INSPECTION BY:-_ __--- Date. ------ ---- ---------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT � i � .130 South American Street � 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Li ES-9-2M , Revised 1.57 F.P.CO. _ t '