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�. APPLICATION I-OR SANITATION PERMIT Permit No. -, (Com tete in Duplicate) P /a 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. S49. JOB ADDRESS AND LOCATION__-------- 1---------- = --••-------- ---- ------ 01 Owner's Name---.-- I' ---------------------------------------------------- Phone-----------------------------... Address---------------------- �----- •`! - - - on Contractor's Name---- ... -•!-•- ---•---- - :----`-�-� - - - ----------- - --------------------. Phone--- -- 7 ' p �Commerci� E] Trailer Court F] Motel Ll Other ElInstallation will serve: Residence,: Apartment House ❑ Number of living units: -1 Number of bedrooml.°1l_ Num �of baths ____I_ Lot size ____4'0---k--AW_ ------------------ Water Supply: Public system � Commun'ity system [S Privaff(e F-1' Depth to Water Table __(/i!1ft. Character of soil to a depth of 3 feet)Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe `] Hardpan ❑ Previous Application Made: Yes 0 No: ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ t No ❑ TYPE OF INSTALLATION SAND SPECIFICATIONS: (No septic tank or'cesspool } ermifted 'if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well---ffaArDistance from founclation'_/O---------Material_`�____._ '1' -------:........... No. of compartments---------Z-....--------_Size-- . - - Zr---Liquid depth______------------- p y---- ® I Ne. Ca acit X_d-_-------- i� 1 I 1 Disposal Field: . Distance from nearest well__, _ _D +stance from,foundation-__c�f9�_----Distance to nearest lot line_ �__. EIry7�� ' Number of lines___.-:_.___/_____________________Length of each line__.__v `__-_____.Width of trench----- _ `r ` e 'F �----------------- Type of filter material_____—ROMK�___Depth of filter material__..--.�-__ ___-_Total length_____e�4___-______________ ---` Seepage Pit: Distance to nearest well--- __D;istance f foundation___..1/* , _.. 0_�_. Distanp to nearest lot line_ _ ____... Number of pits.[--- Linin material----I�mQee-Size: Diameter__ 3A.?—_-______.De th__.___4->-9X_____________- V Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____._______________._______________- • Size: Diameter � Depth------------- -----_--_-_------ _ Lquid Capacity---------------------------- __---------- ------- ---------------- i __________________________Privy. Distance from neaest well- - ---------- -------------------- Dstance from nearest;buifdmg___________ Dcne----- '=- ---------e li - = --- = _ \V� = ❑ I y i r....�-r►• Remodeling and repairing (describe)�------------------------- ------------- ------------- ---------•------- ----- -------------------------------------------- --- z. ------------------ . : , 4 --: ------------------- --- -------------------------------------------------- ------------------ ------)------------�------------------ , . . , a ! -----------------__________________________________-________.-._________________________________------__.__._ __.._-_______________ ,._.___________________-________________________..________________________-____--- __-_-.. ! hereby certify thaf,l have prepared Phis applicafion,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 Distric4. E J 1 i (Signed) ------------ wrier and/or Contractor) By•-------- �r Lr=. =--------- ----- (T e) itl �r� (Plot plan, showing size of Iot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----+,----------------------- = ----------------------- DATE------ ------------ ------- a/ --------- REVIEWEDBY-------------=--------------------------------- --- - -------•-------------- -- �-- =------- -------------------------- SATE---- --------- --- -- - -- - BUILDING PERMIT ISSUED--------------•------------------ ---------- - -- DATE ------ " Alter tions and/or r commendations:______Z __. ��'� -�. •-•-- ,�,' -------- ----------------------------------- ------------ - ------------------- ----- ----- - ------------------ - 'I ------------------ --------------------------------------------- ----------------- ------------------------------------ ------------------------------------------------------------------------------- f II -----------------------------------• ------------------------------------- --•-------------------=-----• -------••--------------------Date--./------------�----------------------------------------------------------- —y FINAL INSPECTION BY._-/f. / =- -----------I------------ �� :� :-_. _-! + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ! 300 West Oak Streets 132 Sycamore Street 914 North "C" Street Stockton, California I Lodi, California " Manteca, California Tracy, California ES-9-2M Revised 1.57 FYC-0. i