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APPLICATION FOR SANITATION PERMIT Permit No. _11-16-7d---- (Complete !_1_1'`d---_(Complete in Duplicate) Date Issued __ _��''__G� 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. JOB ADDRESS AND LOCATION---------- /_�_�— _________________________________ Owner's Name----------1Ne--- _ ___ _ .. Phon%�_4�-1--,! Address-..------------- -- ••------- --- -- -- - Contractor's Name------- - .L_al--- __1 -�- --�- �--- ------------------------------------ PhoneXQ_lP_9/119 ------ Installation will serve: Residence ff"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_._ Number of bedrooms _cP'7_ Number of baths Lot size ___ �_lj�. _____________________ Water Supply: Pubic system ❑ Community system ❑ Private [5"'Depth to Water Table 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 [p-"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sep^tic�T : Distance from nearest well________Distance from foundation-_ --- Mat7ial-__�_v'_�'_-------------------- - L1 No. of compartments-------c>?-------------Size--- X-��---.---Liquid depth---�1��cr7_ ________CapacityZZ Disposal ielcl: Distance from nearest weEL_1. !°._____Distance from foundation-_,/------------Distance to nearest lot line-_,5-_________ Number of lines----------S_ _____ . __�_n_ .____Length of each line___._-__�f�_ _.Width of trench ____________________ Type of filter materia _ t .____Depth of filter matErial___Ze --------Total length_______ ._tea---_____________________ Seepage t: Distance to nearest well_1QQ____._____Distafoundation---1p___......Distance to nearest lot line--- Number of pits___..._________Lining material__ _ om -------Size: Diameter____�,3- ---Depth--- S_------- -- _- Cesspool: Distance from nearest well----------------- from foundation___________________ Lining material____________ -- __-__- ❑ Size: Diameter------------------ -- ----------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________________________- ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------=-------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby c tify tha+ I have epared this application and that the work will be done in accordance with San Joaquin County ordinances, St to I and r s d regulations Uofle San Joaquin Lacal Health District. (Signed)------ -- ------------ ---- ----- ---- --- --- - --------------------------------------------------------- ----- Owner and/or Contractor) o By:------------------------- - - - ---- ---------�/- ------- ------------ ----------------------------------------(Title)------ --------------------------------------------- - ----------------------------- (Plot plan, showing size of lot, location of system n r ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _'-_K_0---------- --- - ---------------------------------------------------------- DATE--------r'�-I �Q---- ----------------- REVIEWEDBY--------------------------------------------- -------------------- -- -- ----- - -11- - --- --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------ ------------------------------ _ ---- DATE------------------------------------------------------------ - Alterations and/or recorgSnendations:_-_ 1=------CV_F_--_:-r_--_/_Vf-I_D_E:;=-----�}-�-��=------L�1_i`C"�-----113rU1.✓- !N P 1RR�_SrE = FK / �1 A , ------------- -------�� !t ----_�tETr i 7-2------ C-'_kN?�----- � ------------ --------==----"- '----------- ---------------- -_--- Pr1 ------N_r= _-_._ aBRl cwTr till----- T �Ntlk_A� K. +u�tV ------------------------ j Z L�f?cKF� ; `7-Ga - ii=- -`--- --- ------ 1 FINAL INSPECTION Date-------- --- -----� -----)------- 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-9-2M Revisea 1.57 F.P,CO.