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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---- Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein-cFescribed. This application is made in compliance with County Ordinance No. 549. J ADDRESS AND OCA ION____ ------- Owner's Name------14 K,--------ary----------------------------------------------------------------------------------------------------------------- Phone------------------------------------ Address--------1_41flmv----- ------- -------- ----------------------------------------------------------------------------------------- -------------------------------------- ------------------------------------------------------------------------------------- I---------------- Contractor's Name-----.------- I Installation will serve: Residence F1 Apartment House El Commercial F Court d2-11 t I El th D Trailer Co t E o e 0 er O)Z/ Lot size;* --------4-7----------------- mber of bedrooms 4.y--- Number of baths '01-p- Number of living units:4- Nu Water Supply: Public system E] Community system E] Private RRI-Depth to Wafer Table _01 ft. Character of soil to a depth of-3 feet: Sand L] Gravel E] Sandy Loam E] Clay Loam eClay I-] AclobeA110Hardpan [I Previous Application Made: Yes E] No � New Construction: Yes P'=No El FHA/VA: Yes-E] -No k;"— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is availa6lei,Aln 200 feet.) 17 ZI; Septisc.TaRk: Distance from nearest well-----------------Distance from foundation--------------------Material-------------- ----------------------- --------- ejE$r14,T No. of compartments--------------------- ----Size--------------------------------Liquid dep.th--------------------------Capacity----------------------- . r �, . , I I k .41 Disposal Field: Distance from nearestell-_,319V-----Distance from fou`ndafion�-------—--------Distance to nearest lot"line---0_�------- dre Length of each line/AV-AP_'%Ob&idfh of trench.:4F------------j---------- Number of lines-------- ------ Type of filter material------- Depth of fiIf1_r_materia1_____/j7r---------flo't,I length__-__ ,r"""-"--""""-" Seepage Pit: Distance to nearest well...... --Distance from foundation__'________Distance----------Distance fo nearest lot line____ Number of pits------ ------------Lining material ize---Dia meter------- ------Depth------2.0 ................ Cesspool: Distance from nearest well-----------------Distance from foui)clation�------------------Lining material__-_______-____-_____--__-`-_____-__- El Size: Diameter-------------------------" - - ------------- - ------------ --------- ----------------------Liquid- Capacity----------------------------gals. Privy-. Distance,from nearest well---------------------------------------------------Distance from nearesf building--------------------------------- -------- ❑ D;sfanc`e"_ to nearest lot line___________________ __1 -1 , \� ------------------------------- ---------------------------------------------------------------------- Remodeling emodeIl—in--g-- an ri d sc.ribe) -- ---- �4-------- ---- --------------------------------------------------------------------------------------------------------------------------------- - - ..... r ------------------------------------------------------------ -------------------------------- ---------------------------------- - - ---- ---- ------4,_�_ --------�R-4� , ..r� ------------- - -------------Q, ��te- !t~- j - _ , . -_ _�ourify, I hereby certify that I hay.= e pr pared this application and that the work will be in accordance with San Joaquin ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed)------------------- --- -------------- ------------ --------------------- `-------------------------------------- --(4?w4!2Czva�Wr Contractor) ------------------ By--------------------------------------------------------- -------------------------------------------(Title)-----"' ------ ---tc'. (Plot plan, showing size of lot, location o stem in relation to wells,,buildings, etc., can be placed on reverse side). 0 s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------T--- --- ---- -------------------------------------------- DATE--------------/ -------------- REVIEWED BY--•------------------ -------------------- -------------- DATE--------------- -------------- BUILDINGPERMIT ISSUED------------------------------------------- -------------------------------- ------- --------- DATE----------------------------------- -------------------- Alterations ATE---------------------------------------- ------------------Alterations and/or recommendations:-------------------------- ------------------- --------------------------------------------------------------------------------------- ----------------- --------------------------------------------------------------------------- -------- --------- --------------------------------------------------------------1-7----------------------------------------------------------- ------------------------------------- ------------------------------------------- ------------------------------------------------------ ----------------------------------------------------------------------------------- ------------------------------------------------- ------- ---------------- ---- ----- - -----------------------------------------------------------------------------------------------------------I------11------- - - ----- ------------------ ---- ---- ------I---------------------------------------------- ----------------------------------------------------------------------- -------------------------------------- ------------------%---------------------- FINAL INSPE�L BY,- - ---------- ----R---- --- --- Date----- +r -w/ f SA ate------- SA JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton; California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P CO.