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4 APPLICATION FOR SANITATION PERMIT Permit No. .�--� (Complete in Duplicate) bate 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 Ordinanc No. 549. JOB ADDRESS AND LOCATION-- -----� _ __. �•ll. Owner's Name_ _ _______ ----------------------------------- Address... - �?- [=ra_ PhoneQ . •---- ------------------------------------------------------------------------------•-----------------------•----------/------------- Contractor's Name--- ------ ----------------------------- Phoney, - - r� Installation will serve: Residence ❑ Apartment House ❑f Commercial El Trailer Court El Motel ❑ Other 2 Number of living units: _1____ Number of bedrooms _L- Number of baths -------- Lot size --- ___________________________________________________ Water Supply: Public system ❑ Community system ❑ Private [Er"'Depth to Water Table 414 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®--Hardpan ❑ Previous Application Made: Yes ❑ No [g-;<ew 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.) y- Septic Ta Distance from nearest well__&_Q__.___Distance/fpm -.Material foundation_______________ (1-2, e gall Q - ---------- - --------- ----------- No. of compartments----- `-------------Size---�!_�o'__ - ----:-__Liquid depth-------��,J�___-_.Capacity --- - U � Disposal F' Distance from nearest weL�_D____.._.Distance from foundation +-_Distance to nearest lot line-------__S___ Number of lines______.__---_- Length of each line_____ A__'___--_�_--.Width of trench_____v ��i�_"*_____F________ Type of filter material- -I-- _.Depth of filter material-___-- "____Total length-----------------� ------_-__-- Seepage Distance to nearest well- __Q---------Distan om fo dation __.Distance to nearest lot line__-_�_r___._ Number of its_____ ll---Lining materiaSize: Diameter____? __./-------Deptn__�-S~_�________________ Number Cesspool: Distance from nearest well___._________-__Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter----=------------- -------- ----------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. 414 Privy: 'earest well--------------------------------------------.----Distance from nearest building------------------------------------------❑ Distance to earest lot line------------- ---------------------------------- ------------------------------- ---- -- ri 6? -------- ---------- Remodeling and/or repairing desc -------••------------------------ -----------i----- _ --- -- ------ - -----------------------------------------•-•--------------------------------------------------------••-------•------------------------------ I Iherek�y rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,// S ate laws,�an ules and regulations of the San Joaquin Local Health District. 'F - (SignSi ed) ----------------- �` } -------- ---- (Owner and/or Contractor) { 9 )------ - - -------•---•--P�---------------- -- ---- -- - ---- - -- ---- -_(Ti tle ------- ----------------------------- By: (Plot plan, showing size of lot, location of system in relation to wells, i i s, etc., can be placed on reverse side). �r FOR DEPARTMEN USE ONLY; APPLICATIONACCEPTED BY----- 771�-0------------ --------------------------------------------------------------- DATE------ 3 --------------------- REVIEWED BY--------------------------------------------------------------------I------------ ---------------------------------------------- DATE------------------------------ ----------------------------- BUILDINGPERMIT ISSUED-------------- •---------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:______________________ _�`____ ---------- .� _/ ------------ -- 1 ----------------------------------------------------------- -------------------------------- - ------ ------------------------------------------------------ ------------------------------------------------------------- -------------------------------=--------------------------------------------------------------------------------------------------------------------------- ------------- ------------•------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -{tt"nmllft� FINAL INSPECTION BY: Date------ r.3/^� +!/ . -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-211 • Revised 1-57 F-P,CO.