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APPLICATION FOR SANITATION PERMIT Permit No. -- _��--� (Complete in Duplicate) pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to constructand install the work herein described. This a lication is;made in eomplianc iLtffCounty Ordinance No. 549. 2!r Z-Z � I& ---------------------- JOB ADDRESS AND LOCATION---_ Owners Name__.: — --�. ---- (�:r�, _� r -d-. --' �„�. v Address-------- '� � � Y � --------- - --- -----•-- Contractor's Name------------------------ --= --- _ - Phone Installation will serve: Residence ❑ Apartment House;❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other .. e . _ �. s Number'of living units: ________ Number of bedrooms _-_ __'Number of baths __-.--__ Lot size :_ ----- i a , . I- , . �•ft. Water Supply:rPublic system ❑` Communify system ❑ Private .�` Depth to Water Table �,____ # - ' Character of soil to a depth of 3'feet: Sand_❑ Gravel ❑ ESandy;Loam DJClay Loam E] } Clay El Adobe Hardpan E] Previous Application Mader ,Yes ❑ ,No �� New-Construction: Yes JR No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or'cesspopermi ol tted'if.public sewer is available within 200 feet.) € .�. �.. �J. Material N _. Septic Tank: Distance,from nearest well- � __Distance from foundation . ' r ` R. No. of compartments----_- -- ----------'-Size----�':� 6_`-�_X� Liquid c!apth--.- Disposal Field: Distance from nearest well L?_0:.Distance from foundation_-_.-- ------Distance to nearest lot line___1A.-.A01__ i Number of lines----------- ---------------- --Length of each line----/ - -----=------Width of trench.._.__:-_-- Type of filter matet ` ial_ T- m K_Depth of'filter aterial___ _y _' l l _ - _--Totaength_'_._ _.L_4�_®------------------- I Seepage Pit: Distarice to nearest well____..__+__._ _ --______Distance from foundation____________________Distance to nearest o line----------------- ❑ Number of pits--------------=------Lining material------------ ---------Size: Diameter Depth Cesspool: Distance from nearest well-----------------Distance from foundation.-- -----.Lining material-_._----_---------_-.-_---.---___-_-- Size. Diameter ---- --- .-Depth- - -Liq ❑ uid Capacity------------- ----gals. Privy: Distance from nearest well__ ___ _____ ___ __ ___ ___ _ ___Distance from nearest building------------------------------------ Privy- __ ..__ _ ______ _____ ___._--_- ❑ Distance ta'nearest lot line ----- -----------, --------- ----------- lng . a Remodeling and/oP repatr�ng (describe�:_�� '��_-------- . ---------`-------•----....---- lam' V ------------------------------------- -- _--------------------------- = *tL - ---------------•------i---- ----------------------------------------------- - -= { z r - f'+ `C„ �'4 `- ----------- -------------------------_---- •--------- - 'I hereby:certify that I have-prepared this application and hat 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) ` ------------ Of ` ----r ---- ------ -------------------- -�`(O(Owner and/or Contractor] --- _ 1 _ -� w 'at t - Title)----------------------- ----- (Plot plan, showing size of bt, location of system in relation f.6-we lls, buildings, etc., can be placed on reve�se side]. FOR DEPARTMENT USE ONLY i ,I/ DATE---------------•-0 REVIEWEDON BY-ACCEPTED BY-- - - �_,Aj 1.1� DATE - �- ----------------- ------------- ' -------------------------------------- DATE---------� ---•-------------- - -- �� Alterafions and/or recommendations:----------------------------------- ---------._ -- -- ----------------- - BUILDING PERMIT 155UEa------------------------------•--------- -------------------------------------------------------- ---------------------------- - k __________________________________-------------------------------_-------_-.____--_ __---_.—_ __.___.__.__._____.____._'___�- • r ' -- ti o eI f� s ----------•-.----- --------------- Date--------------------------------4--------'------ FINAL INSPECTION BY------------ 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.CO.