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f " APPLICATION FOR SANITATION PERMIT Permit No. ____�?.�_3.3.____.. (Complete in Duplicate) -Date Issued _16y1su" Application is hereby made to the SonrJoac;uin Local Health District for permit to construct and'install the work herein described. This application is made in compliance with County Ordinance No. 549- , t JOBADDRESS A>p LOCATION -l---- ----------- -----=....... ------------=------------------------------------------ -------------------------------- Owner's Name t�' r'`' ---------------------------- --------- Phone -------•--- �. Address r s ------- ------------------------ ---------------------------------------------' - - ... Contractor's Name-----------------•- - _.` , Phone -•--- } ' _ k ❑ ❑ railer Court ❑ Motei ❑ Othe ❑ Installation will serve: Residence9-Apartment House Commerual T Number of living units: -------- Number of bedrooms _ i._ Number of baths Lot size ____ ___ _ _ __ Water Supply: Public system Community system ❑ :Private F1 Depthto Water table ---------ft. Character of soil to a depth I f 3 feeti Sand ❑ Gravel El Sandy Loam 12tClay Loam ❑ Clay ❑ Adoberdpan E]Previous Application Made: Yes ❑' No [( New Construction: Yes [r No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or'cesspool permitted if ublic sewer is available within 200 feet.) Septic ank: Distancefrom nearest well___ _ : flistan e fro found tion Se "°" Materia_________________"___________ _______-- No.-of compartments-----=ZZ--------_---Size_�_ - - -----LRquidfdepth-_-'---- .---------'Capacity__ -0-- Dis osal Field: Dis ante from he i I p r r arest well`� Distance from foundation istance to-nearest lot li : I ..r - f( ® Number of lines__'________ __4 Length of each line-- of-trench______.`:_.__ ---- - r Type'of filter materia_ ' '�?.�Depth of filter,material_' : _.______-_Total length- ....... __�+�____-___.-�_____:____ ��il. . , Seepage Pit:'"'," '.7 Diatance'to nearest well-_________ _________"_Distance from foundation_______-.`-.___.Distance to nearest lot line,__` :._________ ❑ Number of pits-.-------- `-----:Lining material----------------`-----Size D ---------Depth------------- Cesspool: Distance from nearest well------------------Distarice from foundation-----.--------------Lining material _______.________-_______------,_____ ❑ Size: Diameter:----- -----------------------------'-Depfh----- --------=----------1 I------------ --------Liquid Capacity-.--.--,----------------=---gals. � Et i Privy: • Distance-from.nearest well.------------------------ . _ ------------,-_Distantce from nearest building ------ -•----------------------._. ❑ Dista ce ---------------to nearelot Ione_.__..__________ -- --------------------------- " ------ --------------------------------------------------------- 4, ----- -------------- --- -------- gs Remodeling and/or repairing (describe):----------_.--------- I ' - �+ ------------------------ -------------------------------••----------------------------------• ------------------------------------------------------------------------------------------------ ----------------- a ------------------------------------------------------------ ----------------------------• - ------------- -------------------------------------- -------- I hereby certify that I have pre6ared this application and that .the work will be done in accordance with San Joaquin-Counfy ordinances, State laws, and rules and regulations of the San Joaquin LoEal Hea District. , ,� (Owner 1 ,or , l ) (Signed)_ ___ P ------------------------------------------ and Contractor (Plot plan, showing'.size of lot, location-of system in relationfto wells, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY ( , t APPLICATION ACCEPTED BY 1 s ( - - - DATE�-----------�----- REVIEWED BY------- ! -=------------------------------------------------------------------------------------- --------•----------- ---- ----------------- - --------------------- ------- ---------------------------- DATE---; --------------------------------------------------- BUILDING PERMIT ISSUED--------�'---------------------------------=--------•-------------------------------i---- QATE Alterations and/or.recommendations"!_ _ --------=---=-...............-------------- ------------------•-•---- -------•-------------"--------------•-"-------- t r __________..___________________________________________________ ------------------------------.----------------------------------------------------------...._______________.____--_--_--_____.-__.__________________s_____.---- ----------_------------------------------------------------- ----------- ----- ___..__"-__.-____""_-_-___ ____________.__._____ _ , FINAL INSPECTION' BY:._ _ - - = - :-----"�.` "Date=-_! = '�' ==� =w SAN 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-9-21x1 , ftevisaa 1.57 F.P.CO.