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r - APPLICATION FOR SANITATION PERMIT Permit No. \� ly (Complete in Duplicate) Date Issued ____3_ � 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. S49- ,r JOB ADDRESS AND OCATIO __iQ_�._ --_ ---.40_.�U.h" ----- ....Axe�- j Q Owner's ame ------ ------- Phone--------------------------- -------------------- U Addres --------------------------- --� - c�-- - U_f -----•---•--------------------- ------ --------- Contractor's Name---.%Y-+ _� �s 1l C� I'hon a �. Installation will serve- Residence ❑ Apartment House ❑ r Commercial— Trailer Court ❑ Mo I ❑ Other ❑ Number of living units: __.------ Number of bedrooms -------- Number of aths ________ Lot size _ Water Supply: Public system ,❑ Com " ity system. ❑ Private Depth to Water Tabled ft." 4 Character of soil to a depth of 3 fee . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 'Adobe Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No - FHA/VX Yes ❑ No is TYPE OF INSTALLATION AND SPECIFICATIONS: u No septic tank or'cesspool permitted if public sewer is available within 200 feet,) ,t. u. eptic ank- ,� Distance from nearest well_________________Distance from foundation--------------------Material -____._ ____.___.__________________._____-- ..No. of compartments---- i--------------------S••sze-------•------------------------Liquid depth--------------------------Capacity-•-•------------------- sal d: Distance from nearest well_ «-_----------Distance from foundation--------------------Distance to nearest lot line_________________ Number of`Ii'es-----------------------------------Length of each line-----_-----------------------.Width of trench------------------------------------- Type of filter material-___ __________ Depth of filter material-----------------------Total length........-_�"`__--__-._-________.__...__"" Sp j p crest well_ :------Distance fro foundation_1�*'--___.Di Lance to nearest lot line-__�_Q_�-"_ e e Pit: INumaber of nts'._�-------------Lining materia!_ ________.Size:,Diameter____ LO-=' Depth:_,�,�.`________.._____ Q Cesspool: Distance from' 'nearest well------------------Distance from foundation---_------------------Lining material------------_----------- _-___--_ ❑ Size: Diameter'-------------- --------- Depth----------------------------------------------- -----Liquid Capacity gals. P Privy: Distance from! nearest well________________ ---------_------_ ______________Distance fro nearest building_ ___________ __ _ i "i ❑ Distance to nearest-lot line----------- -------- , =------ ------ ---- ----- ------ - Remodeling and/or repairing (descrif�eJ:`___ _ -_ k_______ _______ p ------------------------------- ------------------------ ------------------------------------------- -- -------------- ------------------------•--••-- ------------------------------•-----• ----------•--- ---- ---- --------- hereby ertif that I have re aced this application and that the work will be done in accordance with San Joaquin Count ordinances State laws, and rules and regulations of the San Joaquin Local Health District.. q y�fr R (Signed)_ �d Contractor} By ............... ----------------------:---------------•-•- - -- - - --- -(Title)------------------------------------------------------------ ..� . (Plot plan, showing size of lot, location of system in.relation to w;, buildings, ., can be placed on reverse side). 1 = • FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BYs-- ----------------------------------------------- ----------------•----------- --- DATE-- -------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE---.-------- ------------•---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:- Al1 `r[_ �� ---�� 11;_ --------- �-l--- J u ------------------------ f 1 - __-.-----------------------.....................................--------------------------------------- ----------------- ------------------------------------------------------------- FINAL INSPECt BY... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132,Sycamore Strset 814 North "C" Street �^ Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Revised 1.57 F.P.CO. I