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APPLICATION FOR SANITATION PERMIT Permit No�--.--• •----------•• [Complefe in Duplicate!__-_ ---.'-� Date issue 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. ` MR.+7, i�i2/ kS............. ------------ JOB c H c -...G_h_/2•��.e JOB ADDRESS AND LOCATION 1_..1.Q-1KA>Q- '-- r .r ¢Pis Owner`s Name-------------------------------------F&A-1v-k------ Address--------------------------------------------- ----Address------------------------------•------------•- ------------------- ------------------------- ------------------------------------------------------- -------------- Phone----F:::'� - 7--------- Contractor's Name...............•-----_----% - ------- - Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rP- -- Number of baths ./----- Lot size ---- --— n-P ---------------- Number of living units: ...... Number of bedrooms ! Water Supply: Public system ❑ Community system ❑ Private ig Depth to Water Table o347ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam. Clay ❑ Adobe'g. Hardpan Previous Application Made: Yes ❑ No$KL New Construction: Yes,, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` s---...Material.. '`. ---------------- Septti�cr Tank: Distance from nearesr weII D.__"---Distance from foundation-1-6 �� I� No. of compartments---J,-- - Size-r-6. .-__--"-----Liquid depth_.SY--------"----CapacifY--/---- rr; �6„ ' Disposal Field: Distance from nearest well__��1_-...Distance rom foundation...-�.._....-."...Distance to nearest lot line"............... Number of lines.__.......-"...1_..f�_ _-._..-_Length of each line_---pp--��------Width of trench._A_,� --------------------- Type of filter material__.._17---Qj----Depth of filter maferiaL...--�Q__.. -----Total length.-....., Q--- ---------•-----•- Seepage Pit: Distance to nearest well-A-00 Qd_"-------Distance fr m foundation..._._�.�1---_._. isfance to nearest lot line----�__-.... Number of pits._...-------------Lining material.�j ------Size: Didmeter--J_3-«------ Depth_.Za.1r------------------- ing Cesspool: Distance from nearest well__--""..__-..._-Distance from foundation---"---------------- Lining Ca scat ga4s i, i ❑ ial ----- q Capacity ------------------------- Size: Diameter-------"-----------------------------Depth--------------------- ----- Privy: Distance from nearest well---------------------------------- -------------Distance from nearest building----------------------------------- - ❑ Distance to'nearest lot line-- --------- --------•----- ------ ---------------------------•-- -- ------- ---------------------- -----------------------» ' Remodeling and/or repairing (describe:-------------------------------------------------------------------------------------------------------------------------------------------i r I hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to aws, and rul and regulations of the San Joaquin Local Health District. a [�r Contractor) --------------- (Signed) / .. --- (rt i le)- - - gY� ------------------------------------------------------- (Plot plan, showing size of lot, location of system relation to wells uildings, etc., can be pl ced on reverse side]. FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY. ----------------------•------------- DATE.�r`1 ------- ------ ---- -------------------------------------- - I REVIEWED BY DATE---- ---------------------------------------------- t ,-- DATE---------- ---------- --------------------------------- BUILDING PERMIT ISSUED-------------------- . - -------•-------------------•--------------...----------- � Alterations and/or recommendations:...-....-.-_..._"............."...._-..-._"...-_-.-- ------------------------------------------------ -- --- ----------------------- ------------------------------------------------------------- - ------------------ - ----------- ---------- ------- Z49," ------- Date--------------- ------•--------------- FINAL INSPECTION BY---------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street 814 North "C" Street !30 South American Street Trac California Stockton, California Lodi, California Manteca, California Y ES--9-2M 10-52 Revised W-2100