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. j APPLICATION FOR SANITATION PERMIT Permit No. ____- 4?__-,4�.__.. ! a/' (Complete in Duplicate) �� Date Issued ________ _ _________ Application is hereby made 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 LL�OOQCffATI`/ON *---- _�� [ --_ Owner's Name---------- T Phone ------------------------------------ �m---------------- Address_______'____--!_.� l ------------------------ Centractor's Name ----------------------- f,919177L--- --------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence, ❑ Apartment� HouseCommercial ❑ Trailer Court' ❑ Motel ❑ Other ❑ Number of living units: A/- Number of 'bedrooms __ f-_-_ Number of baths -1-- Lot size .� _- .01___�p- -------------------- 3 Water Supply: Public system [Community ystesn ❑ Private ❑ Depth to Water Table ' tft: Character of soil to a depth of 3 feet: Sand E], Gravel E]Sandy Loam ❑ Clay Loam E]Clay E]Adobe-Iardpan C] Previous Application _Made:.(es ❑ No. New Construction: Yes.-.E]No .[L •I FHA/.VA: Yes E] "'No [i}, r TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Sep.tic Tapk: Distance from nearest well ---- ------------ Distance from foundation -------------------- _Material ------------------ .-------- .-------------------- . 1[l T! No. of compartments --1--- 'Size----------------------------- �.� p � --- . _. Liquid depth -------------------------- Capacity------ ---------------- Disposal Field: Distance from nearest well__)j,#WiDistance from foundation --- J®_ ---------- Distance to nearest lot line__ ----- y --- i L" Length of each line-- 01" A T e of filter material---- � 9 J�---------Width of trench----- � -------------------- Number of lines___.-- J/ yG_{.__Depth of filter material� ------ Total length__--_-______________ _Distance from foundation___ Seepage Pit: istance to nearest well__ ___ _�___.Dis nce to nearest lot li�y„�- ___ � 3 �i Linin material_�"f�_Size: Diameter___ _--_.------ Depth ------ -_- 7KY 'umber of pits._____ �------------ .____ ___ . g �� I Cesspool: Distance from nearest well __._------------- Distance from foundation ---- ;--------------- Lining material -------------------------------------- T ❑ Size: Diameter-------------------------- ---------- Depth -----------------------=-- -------------------- ----- Liquid Capacity. --------------------------- gals. . t well ---..f( _._____..._-__..,'___-__.__'..._-____----Distance from°nearest building________________________________ Privy: Distance from neares I❑ Distance to nearest lot line -1 --------- ---------------------------------- '--------------------- I ------------------ I ------------------ I ----------------------- Remodeling and/or repairing (describe):_------ �- -- �Q� �%i��ar+.------- ••---•----------------------------- -------------------------------- y •/ _ I� 4 p - IM. --------------------------------------"----------------------•-•------- Ii ---------------------------------------------------------------------------;------------.--------------------------------------------------•-------------------------------------•-------------------------------------- t I hereby certify that I have 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. , .� _~ Ss ned -� ~ it - - =~ or Contractor] $y: _. ----- -------------rAq.-��--------- 'i� ! l � ----------------------•------- ------(Title)--------- - r---- ------------- --- {Plot plan(Ahowing size of lot, location of system' in relation to wells, buildings, etc., can be placed son reverse side). ;i l APPLICATION ACCEPTED BY --------------------- ____ _ REVIEWEDBY --------------------------------------------- --- -- -- BUILDING PERMIT ISSUED ----------------------------- Alterations and/or recommendations:--.__________- ----------- - ZL FINAL INSPECTION ------- it 130 South American Street i Stockton, California y E5 -7-2M , Revised 1-57 F.P.CO. .1 FOR DEPARTMENT USE ONLY --------------- ----- - - DATE- ------------------------------ DATE.----------- /'----------------------------------- -------------------------------------------------------- } - ------------------ DATE------V_12------------------------------------------ ----------------_-.- ..----------------------------- ._T �1Y as1r� �� ''"x -`� o--- :t,6 ------------------- 1 y ---------•- --------------Date h SAN b OAQUIN CL]CA�ATH DISTRICT I m�� 300 West�Oak Street 9 132 Sycaore Street Lodi, California Manteca, California 814 North "C" Street Tracy, California