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� APPLICATION FOR SANITATION PERMIT Permit No. .. ` 3 (Complete in Duplicate) - ---•--•- Date Issued ! Application is hereby,made to the San Joaquin:Local Health District for a This application is made in compliance-with County Ordinance No. 549. permit to construct and 'install the work herein described, JOB ADDRESS A LOCATION _ - - R.:� ----- --------------- -- --- - _�- ------------------------- Owner's Name------- ---------------- -- ----- ---•----------------- ------•-------- 5'-------•--------•------------------------------ Address one ---------------- ---- --------------------•-------—----------------------------•----------------- ----------•------------------•----------••---- Contractor's Name______ h.-on S '�T �'. ------------------------- Ph o �� Installation will serve: Residence s • � ---�'��'�"""--�"--•- / Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other [] Number of living units: Number of bedrooms _ J~� ,r• -- Number of baths --- _ Lot size __---- 7L J x—Z) Water Supply: Publics stem ----`------------- Y ❑ Comniun'ity system❑ Private epth to Water Table =__ ft. Character of soil to a depth of 3 feet-f Sand ❑_Gravel ❑ Sandy Loamlay Loam ❑ Clay El Adobe E]- Hardpan Previous Application Made: Yes p No El New Construction: Yes [❑ No ❑ FHA/VA: Yes ❑ No F-1 ❑ I TYPE OF INSTALLATION_AND SPECIFICATIONS:- �No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well""�5�----- Distance from fo rldation-- �� %---.___Material--�►!L�-'k No. of compartments__ Z!" Size_" ------- ----- - - A Li uid de th__... ta- " - - �..� q P. - 7-----------=Capacity---•--7 -• Disposal aid: Distance from near t el!__ -�- Disfancrom foundation___" r Number of line's____.__ h_--� "-D.istance to nearest lot line___-_ Length of each line__ _ """"- - ------ - 9, Width of trench.__ �� �! !t Type of {filter materrai____ t> -________Depth of filter material___"/__ "- f i Tota! length-__.l 0_"Q,_—-_--- ___ ) Seepage Pit: Distance to nearest weif............. _--------Distanc T-1 Number of pite from foundation--------------- w _• . .___.Distance to nearest lot line_____. _."_""-_ s----------------------Lining material----_---------_-------.Size: Diameter_----------" ------------------ ---.Depth--------------------------------- -- -------- ----- Cesspool: Distance from nearest well-----------------Distance from foundation---.-----------.----lining material__-___ -------------------- ❑ Size: Diameter---------------------------------------Depth �----------._.:_-=-------------- ------------------Liquid Capacity- ------------------ -------gall s. Privy: Distance from nearest well__ -"_.---------------- Distance from nearest buildin ❑ Distance to nearest lot line__ -------- _ g--""-""" - -------- --------- ----------------------------------------- Remodeling and/or repairing (describe):__-__._-_-""-"--_-"._-""- I --------- ----- --------------------- ---------------------------- --- ----- -------------- - ation I hereby certify that I have prepared this applicand that the work will be done in accordance with San Joaquin County ordinances, S+ph laws, and rules and regulations of he San Joaquin Local Health District. x , (Signed) B - _-- ----------------------- -------- r�•arCon t trac or} Plot Ian, showing of lot location of s stem in relation to Is, buil �} l , r ---------- --- -- --------------- --- ------(Title)-7--- ------ _ size. Y dings, �tc., can be placed on reverse side). OR TME T USE O LY APPLICATION ACCEPTED BY_.__ DATE 1 REVIEWED $Y- >. -- ------ ------------- ---=- DATE BUILDING PERMIT ISSEJED_". ------------------------------------------------------- --------- DATE----- -------- i Alterations and/or recommendations:______________ _ --------~------- ---------------•--------•------•-------------- -------------- ------------------- # . ----------- ---------------------------------- ------------------------------------------------------------------ -------- 'FINAL INSPECTION BY:..____.._..___- _ ' g -E'""" ------------------------------ Date---------- 01 {--- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, Celifornie814 North "C" Street Lodi, Celifornie Manteca, California Tracy, California ES-9-2M Revisoa 1.57 F.P.CO. tis