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�. APPLICATION FOR .SANITATION PERMIT Permit No. • D i n Duplicate) / - (Complete p ] Date Issued ____��.,1.�-�1 This Permit Ex`ires I Year From 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. 549. JOB ADDRESS AND LO TION_-; ------------ ---------------------- Owner's Name------------- ] – ----- ------- ----- Phone � 4_/--�'.,,t� -{ i - Address ---- =_ Contractor's Name ; > Phone... `�� - ------ -- Installation will serve: 'Residenceg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I00Number of living units: __ Number of bedrooms __,9- Number of baths __ Lot size ------_ '�----- --.--+�--- --- - Water Supply: Public system ❑ Community system ❑ Private ge Depth to Water Table -lfl ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AND SPECIFICATIONS: No Septic tank or cess ool permitted if public sewer is available within 200 feet.] Septic T nk: Distant orr ,nearest ell----- ---------Distance from foundation--------------------___-.Material_._________._.____-_-_.__._.__.___________..__. P p No. -----Size------------------------------ Liquid de th----------------- --------Capacity Disposal Field: Distance from nearest well__ __�l�._Distance from foundation Number to nearest lot line------ Number of lines-------------/_-------------------Length of each line------------- - --_--.Width of trench----------------2 . ............ Type of filter material---.- ---Depth of filter material__- _ _'_._Total length----------- -`---------------- Seepage Pit: Distance to nearest well_-_/.a-- l----Distance fr m foundation-_3__Y...___.Distance to nearest lot line------ _ (n Number of pit --------------Linin material- --Size: Diameter___ _ ..--__._.Depth--_---., _�°`__�---- -_--- , Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---_...-_----_-_--..--..------__--_-. ❑ Size: Diameter------------------------ ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from�cnearest well-------------------------------------------------Distance from nearest building--------------------------------------- --" ❑ Distance to neiarest lot line--------- -------------------------------- --- ------------------- ------------------------------------- i �. f Remodeling and/or repair g (describe)--------------- -------- ------------ �•— I e"'r � = �,, :_ •�.--------- --------- +---- ' "--------- -- ------- ------- --- � - - - ------------ ---------------------------------------- •----------------------------------------------------------------------------------------------------------------------------- ----------- - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, "State lawsi and rules and regulations of the San Joaquin Local Health District. (Signed) ------------------------------------------------------------------(Owner and/or Contractor] By:-------------------- ------------------------------------------------ ---------------------------------------- ------- --"(Title)--------------- ------ -------------------- - - _----------- - - --- { (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY T APPLICATION ACCEPTED BY---,-- -------------------------------- DATE`: cam / _ .. REVIEWED BY----------------------------- -- ----------------------------------- DATE-' - -------"-------- - BUILDINGPERMIT ISSUED------------------------------- - --- ------------------------------------- DATE------------------------------------- --------------------- Alterations and/or ' recommendations:------- -------------------- -------------------------------------------- ---------- -- -•---�------------ , " >-.C -------- - --=---- d---- - ------------------------------------------------ -•----------------------: --------------------- . ---- ------ -------------- ----------- ---------------- -------------------------- -------- ---------------- L ------------------------------------ 47 X!71__�_4FINAL INSPECTION BY:----- �� ------------ Date.----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 Was+Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California N Lodi, California Manteca, California Tracy, California 'ES-92M Revised S-'S9 F.P.Co. 1,