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00 r ' APPLICATION FOR SANITATION PERMIT Permit No. -7-Z_!_7. V _ (Complete in Duplicate) /cl '1 Date Issued f._ Application is hereby made to the San J a ui al Health District for a permit to construct and install the work herein described. This application is made in compliance w Ordinance No. 549. JOB ADDRESS AND LOCATION----- --- --- -- -- _4-----.�Fl ---------------------------------------•--- ------.------------------------- 4 Owner's Name--------- --------------------------------------------- ------- ' "— = Phone Address --- ------- _ - - --------------- --- -------------------------------------- (;al ------- ------------ Phone------------------------ - - -------- Contractor's Name-------_ Installation will serve: Residence Ze'77p gent H. se Comm ci�l ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. ___ Numbee rooms _f ar of baths __ __. Lot size /O--------/� ---410-2-1-110 ----------------- Water Supply: Public system UKCommunity system ❑' Private ❑ Depth to Water Table pq ft. 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 Z? No ❑ FHA/VA: Yes ❑ No [ r" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Tank: Distance from nearest well--/��-_Distance from foundation__ _.___Mate ial__._ 1C./ ._ _ _. _ ---------------- Septic _ - � No. of compartments------ --------- ----------- Size A_.X-V.1---Liquid depth--._ "y--�______.--Capacity-- p t I I f Disposal Field: Distance from I nearest well_f'Z' 4?_._Distance from foundation.-/#--_._.__.Distance to nearest lot line___ ,----_-_- �� F " - g Ren th of each -----------Width of trench_._-- _--i` ' _ Depth of filter material---,a� o' .Total length- ` Type of filter material..� _- - --------• g a..'�o�-'------------ --•------------ Seepage Pit: Distance to nearest Distance fr m faun ation___/_ —.. Distance to nearest lot line--- -.----_- Number of pits)--- ------------Lining material,/ Size: Diameter__'..��.__--Depth....,i .a _r_.-------..- Cesspool: Distance from nearest weld---------------- Distance from foundation--------------------Lining material-___-_-_---.-.__--.-----------____.. �) ❑ Size: Diameter-t--------------------------------- Depth-----------.:--------- -----------------------------Liquid Capacity_. t ' Privy- Distance from nearest well------------'------------------------------------Distance from nearest building----------.------------------------------. ❑ M Distance-to nearest lot line-------------------------- -----------------------------------------•---------------------------------------------------------------------- r � t Remodeling and/or' repairing (describe):-------- T s -----=-----------------•--------•---------------•-------- I -------------------------------------- ------------- ------------------------------------------------------ --------------- --- ----------------------------- ------------------------------------------------- ---------•------------------------------- --------- --------------------------------------------------------------- ii ! hereby certify that.1 have prepared this application and that the work will be done in accordance with,San Joaquin County 'V ordinances, State laws, and rules and regglations of the San Joaquin Local Health District. �.• - i (Signed] -------------------- �P*Contract ' ( °r) B Title.r ----". y------------------------------------ --------•-------------------------------------------( ' ] (Plot plan, showing size of lot;loca n of system in relation to wells, buildings, etc., can be placed on reve side). s FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------r------------------------------- ----------------=-------------------------- DATE----------------------------------------------------------- REVIEWED BY--------------------------------- - -----/ ------ ----------------------- DATE----- DATE I 11-- ------- ---------------------- ------------------------------ BUILDING PERMIT ISSUED----------'==------------( -- is_________ --- ------------------------------------------•-------- --------- -----------------------------.--------- Alnd/ mmendatiof___________ ------------------------------------ --------{:---------------------------- ---------------- - FINAL INSPECTION BY:---- .- Date { - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American•Stree+ ) 304 West Oak Street a 132 Sycamore Street ' 814 Nor+h "C" Street Stockton, California I - Lodi„California Manteca, California Tracy, California +- ES-9-2M Reviseci 1.57 F'. -,CO. Y i�