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r� 3r APPLICATION FOR SANITATION PE RMIT Permit No. .�.--I--J-_------ j (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 hereind scribed. T rThis application is made in compliance with County Ordinance No. 549. _ 7_71 e ��/--- leA-------� ------1- JOB 'ADDRESS AND LOCATION_..--�-�-�-f -- ------. - �--�---- -- - ----- ----�-----._... � _. = Phone _ Owner's �e----- -(J--If� ``='�"bi��`�'q - - .,. -- -- fi - Address - _ �g `, . ..... ---- ---- Pi on .__. ,. Contractor's Nam�� --��-�---'�- - --I �*�-�---- -- - ��.��----------- ------------�- Installatian will serve: Residence ❑ Apartment House Commercial Trailer Court Motel ❑ Other ❑ Lot size Number of living units: Number of bedrooms _ Number baths ____- i Water Supply: Public system'❑ Community system,El Private Depth to Water Table��-:--- ft. Sand Loam ❑ Clay Loam ❑ Clay [I Adobes Hardpan El of soil to a depth of 3 feet: Sand ❑ . Gravel ❑'� y Previous Application Made: Yes No ❑� New Construction: Yes No�[[ FHA/VA: Yes El c >"m ' W 11-yo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i . Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material____---._________-.______________.___.-____..-. ❑ No. of compartments_... ----'---=----------Size------------=-----------------..Liquid depth :Capacity gy A i. -'--____Distance to nearest lot line_____ r Disposal Field: . Distance from nearest welLl_4 --'.--Distance from foundation__- __�1 , `f Number of lines._____. _ Len th of each line____- - Width of trench=_, �_ ---- ----- g --.--- - Fes._._ {- (� ,Type of filter material_ .� %'----tDepth of filter material------- _!T-__.___,Total length__. _ ______�•---� kcr.f Nep Pita ;Distance to nearest well____ � t /-Distance rom oundation__r��.f_.___.Distance to nearest lot line-___ -.---- . �Size: Diameter_-- Depth_` t-� _------------- Number of pits------- --------- --Liing material--- {� y- - -+r� Cesspool: Distance ifrom nearest well......-----------Distance from foundation._____________-----Lining material__ __-____.__._____.__________.__._„�„`-� Size: Di I I _� _ .'-- ,•_--_-----:Depth-------- --------------------------------------------Liquid Capacity... -------gals. .--__.Distance from nearest buildingM - - -------------- •------- _ . : i! Distance from nearest well----------------- ------------------------ Privy. "--- "---------- - --------------- ti � Distance to nearest lot line . ` " --------------------------•-----••---------•-----------• I ------------ Remod g an /or repairing (describe}: L E #�1 ------------------_---- -------- ------------------------------------ t ------------------------------------------------------------ ------------- ---------- i �- --------_----- ` _ 11� . �-- —� fe I reby�tify that I have pre ared this application'and that Elie work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1s t dry # f - 1 1 . �os�Contract (Signed}-_,W-- ------- By:---••----- - ---------�1� -----{Title}----- -------------- (Plat plan, showing size of lot, location of system in relation -- we , buildings, a ., can be placed on reverse —FOR' PA�R7MT USE ONLY I = TE:----- -•---------- APPLICATION ACCEPTED BY---- ----------- ------ - -------------- - ------ DATE---------f---•----------------------------------- --------- REVIEWED BY-------------------•-----------------------------------••------------------------- --- -------------------------------------- DATE- - BUILDING PERMIT ISSUED__-____._____-___-_____. - Alterafions and rec mme ations:.- -----"--------- -------------'------------------------------------------------- ------•---------------- �.�1� --- ------------------- -----•-----------------------------------------_----------- ...,. . -------------- ------------------------------------------------- " ----7------------------------------ `-------------------------- Date FINAL INSPECTION BY: -__ . SAN JOAQUIN LOCAL HEALTH DISTRICT ' r. , 814 North "C" Street 300 West Oak Street- t 132 Sycamore Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. { -w ES-9-2M . Revised 1.57 F.P.CO.