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APPLICATION FOR SANITATION PERMIT Permit No. u (Complete in Duplicate) y,,/ Date Issued -_:.- .M!l 7 Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549: .. j JOBeADDRESS AND ' OCATION.----.. i Name Phone Address--------------- � �� _ --------------------------•--------- ------------------------------ Contractor's --•----- ------------ on rector s Name-____k ----___________#_ _ ------------------------------------------------------- V Installation will serve: , Residence � Apartment House ❑ Commercial ----- Pone___________________________________ ❑ Trailer Court El ❑ Other ❑ �l Number of living units: Number of bedrooms -- ) I Water Supply: Publics stem TT ._ Number of baths _7 __ Lot size _-_: 73 { pP y • y "tCommuriity system ❑' Private ❑ 'Depth'to Water Table .3.1571: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Clay' 1. Y ❑ y ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ NoSV New Construction: Yes ❑ Noy® FHA/VA: Yes ❑ No E]I TYPE OF INSTALLATION AND SPECiFICAT ONS: \-. k (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well __`� Distance from foundation_ -_ -_ -10__---_M No. of compartments--_�---------- ----Size_-- r q p. Capacity Disposal Field: Distance from Weare well.___----__-- __ Distance from foundation_ ��}} ' _ __L0___--.Distance to nearest lot �.,i Number of lines-_= _____.� � Length of each line---- " T e / , -'��Width of trench.____p�-- • w----Depth of filter material- ?fV- -------Total len th--- Y- �- - 9 - --- ------------------------------ Seepage Pit: Dista cna e to nearest well__.___ ________"Distance horn foundation___ � , of filter materia! �- Number of its t -�.____---__Linin materia Q -.��tance to nearest lot line___-_. p g l / ZDepth , � + f c � ,� e: Diameter r' -- _•-'' ---------- Cesspool: Distance from nearest wel! ______-_ Distance frg foundation________________ mining material------------------ --size, a ❑.�i Diameter-- --- -- -- --Depth- Liquid Capacity_ .: ;... ,• p Y --------•-- els. Privy: Distance from near_est'well --._ _._. .�-� ' ."�'""°�'� """-` - ---- 9 _Distance from nearest buildin "� crest lot line=-- ----------- ---- -----------• ¢_ V El 9-- is ante one -- ------------ ----- Remodeling and/or repairing (describe]:_.______--_---__- _'' __ ! F . -- - --- ---------------- - ------ ---•-----•---- ---•-------- -----•------ - ----------------- r ---------- --------------------•---------••-------- y y - -------------•--------------------------------•--------------------------------------- 1 hereb certif that I have prepared this application andothat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of: he San Joaquin Local Health District. 1 _ (Signed)-.------• ----------------- ---- - r - ------(OW By:. ----------••--------------•---:----------------�✓ - (Owner and/or Contractor) or] (Title) ----- ---- -- - - ---- ----- (Plot plan, showing size of lot, location of system in relation to walls, buildings, eft., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPL REVIEWEDON BY__ACCEPTED BY ----- -------------------•--------------------------;�----------=4=-�I-•----------- DATE - - ----- DATE---- BUILDING PERMIT ISSUED---------- I n DATE-------------- ------------- Alterations "� and/or recommendations:___--__. __ r --------•---------------------------------------------- ' _f _ ------------ ------------------------------------------------` ----------------------- -------- r ---------- --- -- " "t `n - --_- _ -----•----••---- --• -------------------•--- -- -- --- - ---- _ ._�_ 4" l FINAL INSPECTION BY::---L _ - ! Date---- ---•-------------• ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street „ Stockton, California 8i4 North ”.C Street Lodi, Californie Manteca, California Tracy, California ES-9-2M Revised 1,57 F.P.CO.