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ti ti APPLICATION FOR "SANITATION PERMIT Permit No. --------.S-_3 (Complete in`Duplicafej Date 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. f 1 G`'A4, JOB ADDRESS A LOCATION_ ...,__ r� /f - -- Owner s Name______ • Phone 1 �... Addres514 s l ' : - ----------- ------------*------------------------ - --------------------•--------.........__.. 0 1 Contractor's Na n e _ .... -- u---------=-----------------:-;-;;--x --------------------------i--------------- ----- Phone---------------------------------- Installation will serve: Residence if Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Other r❑ x Number o! lirvincj units: 11--- Number of bedrooms _._ Number of baths ---I___- Lot size ----1_��__0._.X____0Q__-__- Water Supply: Publicisystem(❑ Community system ❑ Privafe Depth t 'Wafer Table __:.____ ft. " Character of soil,'to a depth ofr3Jeet.—Sand .Gravel ❑.,Sandy-Loam .,Clay Loam ❑ Clay ❑ Adobe ,Hardpan ❑ Previous Application Made: Yes ❑ No New Construction. Yes No,.Q FHA/VA: Yes ❑ No -TYPE.OF INSTALLATION AN D'SPECIFICATIONS: (No septic tank oir'c s pool permitted if public sewer is available within 204 fel) �+ $ Septic ;ank: Distance from 'nearest wel d �� } �-�...... tag�f m f,�u�dation�� Materi I t `'c` s" �. No. of compartments____.._______ •___-_-_Size__--__ ' Liquid e•th_`__i___.. Ca city---' .Q Dispfield: Distance from nearest well ________'_Distance from foundationl-�__________�.Distancel o nearest ilotline_,-_f-_1' Number of lines-----------e------r�_----- _.Length of each line------------'6Q--f----_.Width of trench----- -----------------ir-------- Type of filter materi�i ..41' Depth of filter material_ _ length----------- ------------ Seepage Pit: _____-.-___SeepagePit: Distance 'to nearest well _________________Distance from foundation___.____---_----_-.Distance' to neare`s,trlot line----------------- p g .Size: Diameter-----------------------Depth-_. �'.../ El Number of its --------------------Linin material--- -=------ 4---------------------------- Cesspool: Distance.from nearest weN-------------_' _Distance from foundation--------------------Lining material--------------..__.______.___-_----- ' ❑ Size: Diameter--------------------------------------Depth----------------------------------- -- ----Liquid Capacity------I---------------------gals. Privy: Distance from nearest well----------------------------------------------- from nearest buil ding------------ ------------------------- F1 ---_________:___-____❑ Distance to nearest lot line----------------------------------. __- s em4deli ,g and/or repai jing.. (describe)_---_-------------------------------------------------------------------------------------------- ----___------- Q.-; -----------------•------------------------------------------------•• -•------------------------------------------------------------------•----------------.------- ' , ••------------ ----------------•------------------------------------------------------------.- -------------------- -------------------- --- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules and regulations of the San Joaquin Local Health 'District. (Signed)_& - - --I--450 --------------------------------------- --------------------------------------{Owner and/or Contractor] -- , � > = By --- ;..._ = = - = :�;� .� _= ._ .e. .'.- :'_(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-e---------•------ ----------- - -- ------------- REVIEWEDBY-------------------f--- -------------------------------------------------------------------------------- DATE-LV-------------• BUILDING PERMIT ISSUED " �_ .� DATE _ ... : Alterations rd/ar=reaommendations:_' t. s. A------ ---- ¢. ------------------------------------------------------------------------------------ ----------•-------•----------------------------------------------------- -..-------------- -------------------------------------- ------------- ------------------------,----------= •---- 7� W --------------------------- FINAL INSPECTION 6Y:-------- _- Date ��/ a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revisea 1.57 F'P.CO: