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E 4 APPLICATION FOR SANITATION PERMIT, Permif•-No- ___-- 3r3 3" (Complete in Duplicate) ' Date issued 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. s . JOB ADDRESS AND LOCATION__2tt``--1 ---- ------------------- Name---':� ---- -- _ �_�i--¢-�---- �---••-- `�- -�F--•------- ---- ----- ------�------•- -----------•----- -------------------------- Owner's -- -------- --- -- / Address_---...-�-�---�- � �•��.. Phone_ °Y-fp_. _ ._ ---------- Contractor's Name------------------------- - - - - --------------- Phone------------------------- ---------- Installation will serve: Residence Apartment House p Commercial � ❑ Trailer- Gourt L] Mo#el El Other I� Number of living units: ---t Number of bedrooms _,,- Number of baths Lot size ____i I"-.- �(� F . ------------------------- Water Supply: Public system X'tCommunity system ❑ Private ❑ Depth to Water Tablego_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeV Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Ye No ❑ FHA/VA: Yes ❑ No ❑ TYPE,-OF INSTALLATION AND SPECIFICATIONS: emacs„ (No septic tank or'cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from..nearest well_•- 1 Distance from foundation__. -------------- _.__"-_,Material- -LX.- -- "Liquid depth ` .[k No. of compartments_- -- - .--- .---.:Size-- _-- ---------C a pa city--- r T _ - l]f5ta __----- Disposal Field: , Qistance from nearest weft_'______________Distance from foundation___ P-_----_ nce to nearest lot line,-___�_�"_- I Number of lines - --'Length of each line__• _ �'' - --------Width of trench_-- 'Type of filter materiatf- ,� z� _ Depth of filter material___.._/ . _____Total length___ �:� -------------- -------- 1, Seepage Pit. Distance to nearest well 7777n " Distance froF i-fbundation_______ -----------Distance to nearest lot line__.__'___._-____ ❑ Number of pits;---------------- --Lining material---------------- ------Size: Diameter.-------------___-- --- Depth------------- ------------- nearest well----------------- from foundation._-___"_-_._ Lining material____. Cesspool: Distance from n ------------------- --- -------------------Depth--=-----------=--`--- ---:-------- Y•" Distance rom n :...-.,. �.�, . _.,,.. .+ -------Liquid Capacity gals. El Size: Diameter-_ Priv ` , 'earest welt.__-_""_=_._ __" -.Distance from nearest building❑ Distance to nearest lot line:-- - ._Y. J. )' "" Remodeling and/or repairing i t ----- ----------------------" r � """ ) t . .� ----- -- C ----------------------------- --------------Fr ------ ----------------------- -- - -------------------------- '=-----------------.-------------------------------------- - _- -------•---------------• --=--=-----=--------------" :---------------------------- ----------------------------------------------------------------------------=---------------------------•-------•--- -- I hereby certify that ! have -- - ----------`---- ------------ "---- -- - - - Y Y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)Y---- x ----------------------------------- � -------------------•---------------------.(Owner an r Contractor) -------- I" " deo = g/--------•--------[Title -------------------------- i -y"'ste.,. in'r ' ide)-----------------------�i ' (Plot plan, showing size of lot, loca+ion of system in relation to wells =buildin s, a+c., can be laced on reverse side). s i t, FOR DEPARTMENT USE ONLY APPLICATION ACCEPT=D BY_'_ ' } � �- ---____ - ------------------- 1 j _ ---- --------------- DATE--REVIEWED BY--------------------------------- i DATE ---------- -- -----•-- . G BUILDING PERMIT ISSUED - -- A ' ___-- _ - - DATE----- - -Alterations and/or rec mendations ___ - ,- ----- --- - -- --------- ---- -- -------- t- ------- - C -> ------------------------------------------------ �� -------- -- ---------- -- --------------- - ----------------------- = -•-------------------------------------------- FINAL INSPECTION BY:__r;x--_s- -- -` f- - - -- ------------ - - Date---------- ---------------------------- 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-9-2M . Revised 1-57 F.P•GO.