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3� APPLICATION FOR SANITATION PERMIT. Permit No- -____�t_�! t ate...- � (Complete in Duplicate) Date Issued _----________ _---___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described, l This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- -------1A¢''L----- $'3/ 4� Z �'J1 -------- hl Owner's Name------1-11%p_ -------ofd ----------------------------- ------- Phone------------------------------------ Address---------Z� 7-/---•--(P----------------- _ __ 1 Contractors Name----------��R-'s-------'-�'f��`�-----f'eh�l---SesY_�tC-e------------------------------------------ --- -- - - Phone_ 1!` '-- - -�-I--�--�'�-�-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----(_ Number of bedrooms _3___ Number of baths -1----- Lot size ------------------_________________ Water Supply: Public system R. Community system ❑ Private ❑ Depth to Water Table 31-,r___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe © Hardpan ❑ Previous Application Made: Yes [❑ No New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No L�j-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL_N iYe____Distance from foundation---IA-- _-____--Material___ ______________________ ® No. of compartments------- :7--------------Size----- ---------Liquid depth----,_4_'-/----- ---------Capacity...$p-" Disposal Field: Distance from nearest well-_-------------- from foundation---i's_............Distance to nearest lot line---------------- F4 __`_- -____❑ Number of lines____!__________________________Length of each line----------7�rF___._._.Width of french........!9!,/--`-______-.-_...__-._ Type of filter material.__._Tsit,f---------Depth of filter material------/-r_`---------Total length-----2t.�Ja--------------------------- S e it: Distance to nearest well----r-ob-C-------Distance from foundation--:_4.�F`-_______.Distance to nearest lot [A Number of pits___P---------------Lining material------R,,-c & _.-Size: Diameter__.,1k4-__!�---------Depth-------/_0- ----------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------------- .-__----_ ❑ Size: Diameter------------------------------- P --------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well---------------------------_--_______.______._._Distance from nearest building---------- -_------------_° ❑ Distance to nearest lot Iine-------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)--------------------------------------- --------------=-------------------------------------------------------------•------------------------------------ ---•-----••--•----------------------------•--------------------•---------•------------ -----------------•---•----------------------------------------------------------------------------------------=--------------------- ----------------------------- ------------------------------------=--------------....--------------------•-----------------------•------------•---•---=--=-------------------------------------•--------------------------'- ----------------------- --------------- ----------------------------------------------- - - ------------------------------------------------------------------- -- -------------------------------------- �.J I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------- 1---c __ ---------------------------------------------:-------------------- -------------------------------------------(Owner and/or Contractor) By:----------------------------------------------- ------------------------.....-••-.................___------(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------ ®L-� 0--------------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------I---------- ------ DATE.------------------------------------------------------------ Alterations and/or recommendations:-'---------------------------------------------------------------------I. ------------------------------------•-----------•------------ f 1 0 ----------------------------------------------------------------------•------------------------•---•----------•------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY ,/ ----------- ----•--------------- Datef �' ' � SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9---2M , Revises 1.57 F_P.CO.