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} APPLICATION FOR SANITATION PERMIT Permit No. __G___________________ (Complete in Duplicate) U Data 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. p ai. prs.= .�Cgs✓ Q�tr.+e�.s/ JOB ADDRESS AND LOCATION_ - .___ ,.Vf______ � -_ _._ / e_ _ /� _ �..rke,.,j� pp /.... Owner's Name--------------- - --Awe. 8' ------- Phone----------------------------•-=----- r rye ------------------ - ''G Address = _ f�� J / — R t •---------------------------- F Contractor's Name.---------•-------L¢-%D-- 7100- ITS---------------------------------- --------------•-------------- Phone..A-_207.�.7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ Number of living units: �_.___ Number of bedrooms ___ Number of baths -- --__ Lot size -- /� --- X / ,� Water Supply: Publi- system El' Community system E-1Private �epth to Water Table 7_____ ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe �iardpan E], Previous Application Made: Yes E] No New Construction: Yes ❑ No O-`1FHA/VA-. Yes ❑ No [.:r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or�cesspool permitted if public sewer is available within 200 feet.) Septic Tank:' Distance from nearest well-----------------Distance from foundation---------------____.Material------------------------------------------------- No. _______:______-___________________.._____- -.No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------------ !!!! Disposal Fiel Distance from nearest well/-Q.Q- ----Distance from foundation_.ld___--____.__Distance to nearest lot line--,_.____- Number of lines_._._'__ ________..__.____-__Length of each line____ a__._�..........Width of trench__ _�l... .___------ Type of filter material.. _QG__! ___Depth of filter material-- length------_'S_W__------------------------- Seepage Pit- Distance to nearest well_/Q_O_---------Distance from foundation_.,Q_:S---------Distance to nearest lot line___S•------- Number of pits_____---------------Lining materiaL__.Y_[��1 __Size: Diameter----y�Z_.._______.Depth--- �_________ L `I Cesspool: Distance from earest w.ell___.____. Distance from foundation�-----�`._:�------Lining material__________________________ ❑ Size: Diameter----:--i-----`-- ------Depth----- ---== __---------------E'-------Liquid rCapacity---------------------------gals. Privy: Distance from nea est well_________________________________ `________Distance fronearest'building--------------.__..__------------------- ._. I ❑ Distance to nearest lot line-----_----_--.--- Remodelingand/or repairing describe ____________________ _______________ x -----------------------=----------------------------------=--------=--------------•-----------------------------------------------------------------•-=---------------------------•---•----------•-----------------------•- ' --------------------------------------------------------- ---------------------------------------------- ---------------------------------------------------------------------------------------------------------- i I hereby certify that I have prepared Ais.application and that the work will be donelin accordance with San Joaquin County ordinances, State laws, and rules and-regulations_of the,San Joaquin Local Health District. (Signed) _ __ D________ ------o t - '� --=-"- --`- --- _l__------(Owner and/or Contractor) - ---`------------------------- By: -. (Title; (Plot planhwif Ilocation of system inrelafion +i! buildings; etc., can be placed on reverse side). r i FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY--- _G.C - ----- ------------------------------------- DATE-------Ia - W-------------------------- REVIEWED BY-------------------------------- - i' ------------------------------------------ DATE.------:.---•-' ` BUILDING PERMITISSUED ri tions------------------ `' j 3 A E ---------------_------ i� Alta ations and/or ec mme da __.__ _ __ 1 • -e f *4 ------ - - -- •----- - _ -- --------------------------------------------- --- - ---------------- - k d { -- -`-------- --------------{ ------ 4-.------- ------------------ --.--.::_-— n�, FINAL INSPECTION BY:.. �'r`".4- = =Date-- ---Ia c� d-- - --------------------------- SAN JOAQUIN LOCAL^HEALTH DISTRICT 134 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 Revised 1.57 F.P.CO., f