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f ` Permit No. -._d APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) pate issued _N-1 ----- Joa u'sn ocalHealth District for a permit to.consfruc nd�nstall the wor�he ein described Application is hereby made to the San q�L fi+�3T) This applicatioh is made. in compliance with -County Ordinance -No. 549.' r �. fiZZ3t..iJo✓E -r s JOB ADDRESS AND OCATiON.--,l�_ �iY� /`�� Q�'°� L_.- C =4► --•- - [ ..� _ Phone------------------------------------ I ule- -- ---------------------- �- _--------•------- -- - Owner s Name_______ Y 1 -- --- ------ --•-- Address ----------- P$1one. Contractor's Name---- ----- - - ------------------------- ------ - - Installation will serve: Residence �- Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ Number of living units: -/__-- Number of bedrooms _ .- Number of baths _14 ' Lot size _- � Depth to Water Table _� t Water Supply: Public system ❑ Community system ❑ Private ❑ P Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑, Sandy Loam ❑ Clay Loam la ❑ ❑ Previous Application Made: Yes 171No ['� New Construction: Yes �No ❑ FHA/VA: Yes [�"-N o [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or` cesspool permitted if public sewer is available within 200 feet.),, �• - Material__ � ---- ---�k/`- p- --•--- -- Ca pacify- C,��-�, Septic Tank: Distance from nearest well __a�_a__ Distance from foun anon"- --- - �� No. of compartments..._ /� -------Size_�k -A- - Liquid depth---- -- -------------w P Y �� �`- ' _ Distance from foundati-_l•�----------Distance to nearest lot ne`___.,__-__ Disposal Field: Distance from nearest welWidth of trench.__ ,�----•----- aN. ❑/ Number of linas________f--.--_---------- -Length of each line ------- � �� Total len th_____---:M-----•- -�--- f --- Type of filter material-/= Depth of filter material--/ g ; ► f �ti,[____-___.Distance to nearest lot line__��--_--.- i Distance f om fo ndation___ _. Seepage Pit: Distance to nearest well__ i ---------- Number of pits ----- -------------Lining material. �� --Size: Diameter__--------.Depth---�� ----- } Cesspool: Distance from nearest well ___--__________Distance from foundation __________________.Lining material ________-_______-.----------------- I Ce p Liquid Capacity _-__gals- ❑ Size: Diameter--------------------------------------Depth------------------------------------------------- q P Y- ---------------•------ Distance from nea-rest building--------------------- ------------------- d Distance from nearest weH_________--------------------- Privy:--------------------- 9- ❑ Distance to nearest lot line- --------------------------------- -----------" - -- �Yml Remodeling and/or repairing (describe): --------- .-/.�/��----- -- �i.�. -------------------•----•---- ------------------------ ---------------------------------------•------------------------------------- - --------------------------• ---- - - ---- --------- - •------- - - - --•• --- have epar hi done inlancesbState ilaws�aand rules and regulationapplication alf the San Joaquin the L calwork Heawill l Health accordance with San Joaquin County ) ordinances, _--( Contractor) (Signed). ------------------------- --- -- - -------------------------------------------- (Tit e)----A'�1.�/L'l' By: ------------------------------------------------------ (Plot plan, showing size of lot, location system in .relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---- DATE--------------- ----- -4------------------------------ APPLICATION ACCEPTED BY-----=---------- ^---------- --- --------------------- DATE ----- _g-- -3- �'' --------------------------------- ------------••-----------•-------------- I REVIEWED BY DATE----------------------- •-------------=---------------------- BUILDING PERMIT ISSUED-__ ---------------------------------------------- ------ --------------------------------- Alterations and/or recommendations---------------------------------------------------------•-------------------------"--------------------------------------•--•----------- --------•----------- -----------•-------------------------------------------------------- -------------------------•----------- --------------- ----------------------=---------------- ------------------- -- ----------------------------------------------------------------- ---- Date-- �:----------- FINAL INSPECTION BY:____ c--.. - SAN JOAQUIN LOCAL HEALTH DISTRICT , 132 5 camore Street 814 North "C•• Street 130 South American Street 300 West Oak Street Y Trac California Stockton, California Lodi,' California Manteca, California Y• ES -9-2M Revised 1-57 FY CO.