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APPLICATION FOR SANITATION PERMIT Permit No. ._� /Z•_ l (Complete in Duplicate) -- —. -- Date Issued ... S+� Application is hereby 'nade 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 LOEATION_..__ 7` - -- j,�,�J �f t t^ f _ _ - �Owrter's Name-- _ - `�•= fFG� f�c - --- ------------ - ----------- PhoneAdd r - Contractor's Narne--------4U-7 = f_" '' �_�!�✓'---- -vim -----------•--•----•-°•------•--------•----------•-------••-------•----------•----- ----------------------------------- Phone_ Q�.77 Installation will serve: Residence ® Apartment House C . ommercial ❑ Trailer Court ❑ Motel El Other 11Number of living units: J--- Number of bedrooms __ 'Number of baths _f__..Lot size .__-.-_ __- __ ____ ------ Water Supply: Publics stem i I pP Y� y Community system ❑ Private Ej.;�Depth to Water Tabl -_ {}, Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑` Cla Loam Clay Previous Application Made: Yes ❑ No New Construrtion: Yes, - Noy ❑ ❑ Adobe ® Hardpan ❑ I ® ❑ FHA/VA: Yes ❑ No. TYPE OF INSTALLATION AND SPECIFICATIONS: 13 [No septic tankeor'eesspoo! permitted if public sewer is available within 200 feet.) SepticlTank: Distance from nearest well__AMae�-_ Distan e`fro �,foundation-1/0 7° grial__ --- '{C" I� No: of compartments------. 2------ $ize_ "-" Liquid ------------ depth_ j_-:t- Ca aci# y- p Y � I Disposal Field Distance from nearest well__-NA+V " :rDistance,from foundafion _��-_____'Distance to nearest loge__ __. , Number of lines.___._: --- - - Len th of each line__ g �------- Width of trench.sw Type of filter materi Fr r ---•------ 0�epth of filter material___;�� ------:Total length-----c>'10_-__- �• o Seepage Pit: Distance to' nearest well___ e - Distance om fo dat.io «t_- __.Distan to nearest lot line Number o{ pits---- ------------Linin materi r g r .To Diameter ' , Depth ------------------- d Cesspool: Distance from nearest well___=_-.._____--_Distance from foundation--------------------Lining material-------------------- nSize: Diameter-------- ------ --------- Depth 4 _ ` T".'.----Liquid Capacity---------------------- ----gals. \ Privy: Distance from neare '' + Ll I } stwell__- - _-----_---____.t�- --_ Distance from1771 nearest building 4 Distance to nearest lot line_- `-•-yr--�. g---- -------------------------- - -------------------- Remodeling and/or repairing {describe) t p =--------------- - ---------------------------------------- -.=--- i l ---- •--------- ---------------------------------------- --------- -----• -� a -- his a ----------------------------------------------------• --- --------------------------- ! hereby certify that I have prepared this applic tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations ofthe Se oaquin Loacall District. f ' (Signed)------- ' -z� -_- - X,], nd/or Contractor) -- -- - ---------------- ---- --------------------------------- (Plot plan, sham sae tat, loci ;on ystem in elation to wells, buildings, etc., can be placed n r ): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------------------------------------- DATE------ 1� REVIEWED BY DATE - -----------------BUILDING PERMIT ISSUED--------------- '-------_-- ---------------------------- --- ----------- ---------- -- ---=---- DATE----------- ----------- ------------ +erations and/or.recommendations:'P.______________ --------- 1. ------------------------- - - � -•--- -•--------•---•---------e---- .----- ----- - ' ------------------` i ! --•------- --- --------------- FINAL--INSPECTION..BY:-__,. ._. �, - + :AAG r cs - - ----� ----------- - D �'-----� ate----- - --- ----"`R. �. `--------- ' USAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2M . Revisea 1-57 F,P,CO.