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No lS 1 APPLICATION FOR SANITATION PERMIT Permit . . -�. JJ . 1 (Complete in Duplicate) Date Issued _.7�.P____-. 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. JOB ADDRESS AND LOCATION---------`7Q-0___ ..... .�1 -�-------------------- Owner's Name---------- ----- _ Phone------------------------•----------- - -- - - --- ---- -. Address_________�L�__y�`_Z_______ 1_�_r i�Z_c -------- � C -------- ...... 5 ��---�-- -- Contractor's Name-----------f ]�----- - ---- -f? - cz7r Phone. _ a� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms _A Number of baths __/___ Lot size _ -X-1_ ---- ------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table a0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 5eptit a Distance from nearest we!-----------------Distance from foundation___________________Material------------------------ _____________--__--___-_. No. of compartments--------- ------..___Size---------------------------------Li uid de th_____---_- ---------------Capacity•---------------------- Dispo � d: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_---_____-______ T ! Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material---.----------- Total length---------------------------------- S --------------------------_----- -- V Seepa e Pit: Distance to nearest well________-_--Distance m foundation_/a------------Dist nc�erto nearest lot line .____ 0 Number of pits_______------------Lining material__-- ___.._CI --- Diameter.____J��._______Depth____��--------------- esspool: Distance from nearest well_________________Distance from foundation----_________-.____.Lining material-----------------------.--------_____. ❑ Size: Diameter---------------- -- -------Depth--------------------- -----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ElDistance to nearest lot line-------- ------------------------------------------------------ -------------------------------------------------------------------- Remodeling and/or repairing (describe ----•----------- ---- ---------------------------•--------•-------- -- -----=---"rr----~--------- --- ---------- r--J ------------------------------------------------ ------------------------------------------------------•-------------------------------------------- ------•---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applica ' and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an egula ions o the S n Joaquirk-Local Health District. (Signed) ------ - - --- -- ------------------ Owner and/or Contractor) g _ By:----------------------------------------------•-•------------------- ----- ---- --� - ---- ---(Title) --- - Plot Ian,-showin size of lot, location of system in r a ion to wells, buildin s etc., can be placed on reverse side). ( P g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- 4--�- -:-: - - - ----------------------------------------------------------------- DATE----- -—------------------------------ REVIEWEDBY- �------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------- -------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------------------------------------------------------•------ --------------------------------------------------- -------•-•------------------------------------------•------------ ----- f---------------- ------------------------------------•--•------------------•--------------- - -•--------------------------r'1'T _�.Trt --------1-6--- ---Q K-------------)_-__7-k_0--------------ITR.a---------------------------------------- ----------L FINAL INSPECTIO �Q ---- ----- - - Date---------1-4-- 0-4�0----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1•57 F,P.CO.