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ry 1' PA APPLICATION FOR SANITATION PERMIT Permit No. 8 J�_____ l i Ot (Complete in Duplicate) Date Issued ___-•- --y�5--. - 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 LOCATION----------c�� ` _ Owner's Name / ' ..... ---------------- ----------------------------------------------------------- Phony Address-------------- ,�o��`J = ------------------------------------------------------------------------------------- Contractor's Name-------- rt.----- fl�i C,e cs---- - ��c �..� 4?1----------------- Phone.._P_v__---- _ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_j___ Number of bedrooms -2:---Number of baths I____ Lot size ----/-----��_--------_---------------- Water Supply: Public system El Community system ElPrivatev Depth to Water Table _'f_Uft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑. No R New Construction: Yes ❑ ' No Eke FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well___ __ '0 __Distance from foundation---------___--Material__.__�/� _______________ No. of compartments-------�__---------Size------Z-` - -----Liquid depth-------- Capacity....8!0_0-----f. Disposal Field: Distance from nearest welL_._�_O_`__._Distance from foundation__�.,�yX----Distance to nearest lot Number of lines----------/----_ -----------Length of each line________4-P-------------Width of french.......;�-__50" ...... Ir Type of filter material_-___- ----Depth of filter material------ ____........ otal length_______��____--------------------- Seepage Pit: Distance to nearest well_.__ih�y,I________Distance from fou dation__// ....___.Distance to nearest lot iine___.e.1__.____ Number of pits--------,0----------Lining material----XVC .Size: Diameter____j_3------------Depth__.,;_> ,S_-�---_ _ -_--- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------__.Lining material-______________._____-__-----_---.__ ❑ Size: Diameter---- ---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. V, Privy: Distance from nearest well--------------------------------------------- --Distance from nearest building------------------------------------------ �] Distance to nearest lot line--------------------------------------------------------------------------------- -••----------------•---------------------------------------- Remodelingand/or repairing Idescribe)---------- - --------------------------------------------------------------------------•-----------------•---------------------------------------------- --------------_ --------- ------------------------------ ----------------------------•------------------------------------------•----------------------------------------------------------------------------------------------------------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 laws, rules and regulations off the San Joaquin Local Health District. -- Owner and/or Contractor} (Signed)-•----------------- - �j By:-----...... C -------------------------------------------------------------(Title} f ------- ------- (Plo+ plan, showing size of lot, lata+ion oys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE - - -- ------------------------- REVIEWED--B--Y------------------------- Y -------------- ------------------------ DATE-------------- --j---------- BUILDINGPERMIT ISSUED-------------------- ---- - ---------- ---------------------------------------------------- DATE T---,--------------------------------------- Alterations and/or recommendations:---- -- -- ----------------------------- -------•-•------------•- ----------•-------------- `� -----3------------------••--•------- --i�-------•------------------------------------------- --- - ' -----------------•------------------•-•--------------------------.._._.. . ---------- -------------------- - ------- -- --- - ---------------------------------------------------------------------------•-------------------------------------.--------------------------------•------------------------------------------------+ FINAL INSPECTION BY:.._- _ _�1 Date----<-._�r~f- �--- -" 7 . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C Stockton, California Lodi, California Manteca, California Tracy, Cali{ ES-9---2M Revises 1-57 F-P.Co.