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E; APPLICATION FOR SANITATION PERMIT Permit No. _A? 2-n-'10 a (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. This application is made in compliance with County Ordinance No. 549. ic B ADDRESS-A"ND, LOCATION c 2, />0, L��f1,CI �� - ------------------------------------- a t Owner's Name ` - ---- GerPhone l�t -- - -- ---------------•Address___------_ ;1 Contractor's Name -- Phone------------ --------------- - ----------------------------------- ------------- Installation will serve: Residence•;4-,Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I Number of bedrooms .-t---- Number of baths _/____ Lot size Water Supply: Public system X'Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam P�--Clay Loam❑ Clay ❑ Adobe,K Hardpan U Previous Application Made: Yes ❑ No)1�1. New Construction: YeNo FHA%VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank.: Distance from nearest weIV �..([�'"___- Distance from foundation`__ _ lx° I Materialq�`l1t_ __- No, of compartments------� Sizer -- _______Liquid'depth____t _____. CapacitY.___ " Disposal Fi :_ Distance from nearest weI0_3T_-,R1t�, ,Vld Distance from founciati _, _ Distance to nearest lot Ii e.,o�Q_______- Number ofdlines_____ Length of each line_____ A r^} ,� 'r Width of french--'?--�_____________________ Type of filter material-_ _ __ __ _--____Depth of filter material___,f ---------------Total length----46-4!__<_______________________ Seepage Pit: Distance to nearest well----- ----------------Distance from foundation__________________.Distance to nearest lot lineL _ _______.______.._ El Number of pits----------------------Lining material--_--------------------Size: D;ameter ------ -----------------.Depth-------------------------------- ` Cesspool: Distance f4om nearest well-----------------Distance from foundation-------------R._�Lining material--------_---------------------------- . ElSize: Diameter------------------------ -------------Depth------- ------------------- ---------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well_____________________________-_______________.__Distance from nearest building._________.___:__._----____________-___. ❑ Distance to nearest lot line------------------------- s Remodeling and/or repairing (describe):_-__ _4t:Y` c - ----- - _ ------- [ = ------------------- - - - ` Q__.-QvF - , �� ------------------------------------------ I . - ---------- -- � --------------- I hereby certify that I haveepared 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)--------------- ---- -- ------�-------------------------------------------------------------------------------------------- --------- (Owner and/or Contras+or)- - _.r.. By:.-.-Ee _____ (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 0 APPLICATION ACCEPTED BY------------ ---------- ------------------------------------------- DATE- , - ^ ---------------- REVIEWEDBY------------- --------------- --- ------- ---- ----------------------------- DATE = Y s BUILDING PERMIT ISSUED------------------- - -'---- ------------ DATE------------------------------ �-------- Al+era+ions and/or recommendations: ------------ - ---•-•-•----------------•------------------------------------- ------------------------------------------- J, ------------------•-------•---•-----------------------=-------------•---—----------------------------------------------•-----------------------•---------------------------------------- --------------- --- --------------------- /S_T_.1R� - �� 1NT�----- G"±.{ RS �M TD'SL_M - I'/3--6 a ----------------------SyS r ------f S------Fu__N r-T nl vl4 -------� ----'�` --------------------------------------- -------------- ----- ---------•------ - - FINAL INSPECTIOr �. - -- - Date------- -�,� T -0 SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M , Revised 1.57 F.P.CO.