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\� i APPLICATION FOR SANITATION PERMIT Permit No. M� I ' (Complete in Duplicate) ��--� - N_ - Date Issued -- t 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' Qrdinance No. 547. JOB ADDRESS AND ATI N____� -------- O � e - Owners Name ------ ---- --- --; ----------------------- Phone.- `�� ` Address-------------....... .. . --------- -------- - ---- ----------------•-• ------------------------------------------ --------------------------------- Contractors Name----- - ------- Phone07 Installation will serve: ' Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Mote! E] -Other,❑ Number of livi gun i t s: _--L__ mber of bedrooms __yNumber of baths ----?__ Lot size ------ �1_-70- --_--_ -x Wafer Supply: Public system. Community system El' Private ❑ blft. "Depth to Water Tae a Character of soil to a depth of 3 fee+: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam E] Clay E] Adobe �ardpan ❑ Previous Application Made: Yes ❑ No W1-*0'New Co_nstruction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or'cesspool pe'rmif+ed if public sewer is available within 200 feet.) t , - R.- Septic Tank- Distance from nearest well-__0_F__�_;Distance .from foundation- .. Material-- -- - --------------- No. of compartments_-_- --------------'_S ��_ .�•_--Liquid.depth.--. - --------Capacity=_..- -= ------- Disp ._._ osal bid: Distance from nearest welLQ.._Distance rom foundation__ `':_..__Distance to nearest lot line__, _____ [ Number of lines-____-1---_._ --__A--------Lengih`of.each Width of trench-1--_e2 f- Type of Ctee'rr aterial_ __ s._ __k Dep"h of filter rijaterial_------?'00,��__Total length------ -------------------- Seepage Pim^ Distance to nearest well_ /4-- ,5 -_,-Distance from foundation_-: -_.-..Distance to nearest lot line.---_ Size: Diameter_____ __ Number of pits---- =.-----------Lining'material_. ._--t--- . --------.Depth_-�-- - -------------- Cesspool: Distance frcm nearest well-----------------Distance from foundation_._.__.-_-..---_--.Lining material--------.--------------.-._.---------- ❑ Size: Diameter-----,--------------------------------- --Depth----------------------------------------------------Liquid Capacity---------------------------gals. � Privy: Distance from nearest well______ ____ ____x_ __..________.______--...._Distance from nearest building__ ____.._._.____________________--__._. i ❑ Distance to neare`t lot line-----------:'-----1_ =_ ----•--=---------------------------------- Remodeling ------------------------- -----Remodeling and repairing (describe)=---------=--------- ----- ---------------------------- --•---- - --------- --- ,r f i ' -- --------------------------------------------------:----------- -------------------------------------•------------------------------------------------------------------------------------------•----------:--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and r gulations of the San Joaquin Local Health District. f -.5 ----------------- �___1__._. :__ ------- 'By: _©w er (Signed)•----•--•------------ ---- - ------ ---------- -------- ( r Contracto 'B •------------------- --- ------- --- --J- ------y--------------------------fe------- -- ---------- -._ (Title(- ��F ----------------- Y• -- (Plot plan, showing size of lot, location of system in relation wells, buildings; etc, can be pl ced on reverse side]. � . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �` = ----------•:-------- ------- DATE -------•--------�� -:777--- REVIEWED = REVIEWED BY-----------�:-----------------------' � � � � �1 � ----------------------------- DATE------- -� BUILDING PERMIT ISSUED---------- !_�------- -------{ -------------------------------------------- DATE--------- -------------------------------------- Alterations - --------------------------------Alterations and/or recom �m ---=--------------------------- -------------------------------------------------------------------------------------------- -- ---a -- --------------------------------------------------------- --------------------------------------------------------------------- - 'F T ----- -----------._--__ '..0a r FINAL. I NSPECTlONt,BY: - L ----------------------------------------- ' eet ---- - - - - --_ Date ----- SAN J AQUIN LOCAL HEALTH DISTRICT 130 South American 5f " 306 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 'y } +Lodi, California Manteca, California Tracy, California ES-4-2M . Reviseu 1.57 F.P.Co. i