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-0 ,. 9 r �e ! I APPLICATION FOR SANITATION PERMIT Permit No. --___-.- ' (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 Co u ty rdinance No. 549. s JOB ADDRESS AND LOCATION___ Owner's Name _ ("p+ moi '' I . ---... PhoneA -/ ------ - r,. :1L•4 � ../�`l .�.�., i cam. , r•—' - F _ -- --------- -- - ' - - qq Contractor's Name-------------------------------- -------------------------------------------------------------------------------------------------- ,PhonE ..-- --------------- Installation will serve: Residence M" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel[j Otl er [I Number of living units: __j____ umber�of bedrooms.' Number of baths -4----- Lot size-___• SO _. _'-_ _l�------_-------_-------------- x ., Water Supply: Public system. + Community system ❑ ` Private.2/Depth to.Water Table ' -----_-ft.''°' Character of soil to a depth of 3 feet: Sand I❑ 1 Gravel ❑ Sandy Loam Clay Loam'❑ Clay ❑• Adobe 0%Hardpan C]Previous Application Made: Yes E] No P__'New Construction: Yes No ❑ FHA/VA: Yes ❑ Na TYPE OF INSTALLATION AND SPECIFICATIONS: ( N • P P P fee Septic Tank: Distance from nearest well______:_____-Distance from foundation____Y u No septic tank or cess ool ermitted if lic sewer is available within 200 E Material i �- +_i: a��_t�k, p ---------------- r ----- - ®� No, of compartments-_-_ ___ _..Size_' --- #___::!1 li' ._ _-Liquid depth___ �_r_.__ ''_____Capacity Disposal Field: Distance from nearest well.7- ---------Distance from foundafion _4- _________._.Distance fo nearest lot line ___.__. Length of each line------------ _ } -Width of trench.___2'——-_._-.___- © Number of lines__'___--------_ _________ ___Leng `filter mr aterial______ __,_____.__Total length___.-. _!�-_ _______________________ Type of filter material---A44k :_Depth of Seepag Pit: Distance to nearest well_.."47.:---l-Distance from .foundation_'!(t--`=___.Distance to nearest lot life �-.__..___ 4� -__9 rr Number of pits---4__` -------------lining material.( ------------S- .- ize: Diameter--- ---__...___.Depth-----�-'----------------------- G� Cesspool: Distance from"nearest well--_______________Distance from foundation--------------------Lining material__.______________._________._______ ❑ Size: Diameter`--N — ----:--- ---Depth'------------=--ti.---=-------- - -----------------Liquid Capacity----------------------------gals. k.l - rrvy: Distance from nearest well__._____---I',_`�'�_________________'_---`----Distance from nearest building_________..______________ �«� ❑ - , Distance to nearest lot line- '� ---------------- ----------------------------------------- ---------------------- t--------------------------------------- Remodeling and repair ng (describe] °•� �' 7-1 t -----------------� -`:-,�-- •_------ •----- -----•-- ---•----------------------------------------- =-------------------- ----------- ---------------------------- --------------------------------------------------------------- a -------------------------•--------%•-----------•-----------------=-----•--------------------------.-----•---------------,---------------------•--------------------------------------------------------------------------- I hereby certify that] 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. `°`�=r " e _=__.__. tsar dor Contractor (Signed � w an ) (PlotgY� = ��±, ! ~-- ----------------------------------------•- --------=---- (Title)----- �:(.n ------------------------------------ ( plan, showing si4 of lot, locationf system in relation to wells, buildings, etc., can be placed on reverse side). � �r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------- ---- -- ------------ --------------- DATE REVIEWED BY ---- --------------- ------- ----------- DATE------- � . BUILDING PERMIT ISSUED-- ------ - ----- --------- - -- -- - ---------------------------- DATE.------------- -- - - Alterations and/or recommendations: r -------------- -- •----------- ---•-----------------------•-------------------•---- •;------------------- -----------------------------------------------------:----------------•-----------•---------------------------•-----------•-•---•---= -------------------•-----------------------•---.... ----------- ---------------------------------- --•-----.. ---------------------------------------------------------.--_------------------- ........... ---------------------------------------------•----- ---------------------------------------------------------------------------- ----------•----------------- ---------•--•-----------------------------•-••-•---- -- - ------------------------------------- ------ -----------.- ---------------------•---------------- - -----------------------------------------------•----------------- ----------- ------------------------------- - _-------- ---- I i ' FINAL INSPECTION-By:----- /'_____._ - Date_/(/-_�'-U ~- -- : SAN JOAQUIN LOCAL HEALTH DISTRICT E � W 130 South American Straof 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M , Revisoo 1-57 F.P.CO. /