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�� 1.{�T I r � �� - _ � � � APPLICATION FOR SANITATION PERMIT Permit No, .Z.�._K (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and installfhe work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION -------- _7!------------------------------------------------------------------------------------------ Owner's Narrie--:----------- -Phone- Address----=-------- - ------------------------------ • 4 - ---------- ---------------------- = ------------------------------------------------------------------------------------------------------- -------------- Contractor's Name---------- /V 0-3-1r, /A/,!�,_6 U -------------------------------------------------------------------------------------------------------------------------------- Phone Installation will serve: Residence Apartment House [I Commercial E] Trailer Court E3Motel [] Othqr ❑ Number of living units-. �----- Number of bedrooms ___/_.. Number of baths/____ Lot size---__007-,kIM—---------------------- Water Supply: Public system §2- Community system [] Private E] Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: ' Sand Ej _GrqyeLE] Sandy Loam E] Clay Loam El Clay El Adobe j!�► Harclpan E] Previous Application Made: Yes ® No E]. New Con sfrLYcTi bn--Yes6��oja,� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: e (No septic tank or'cesspool permitted if pulic sewer is available within 200 feet.) Septic ank- Distance from nearest welbisfance'�;omfouniation--7/®__._____..Mat jF I . - - I/ - No. of compartments------2t-�=--------_S' e_CF.4 iz -------Liquid de;�fh depth----- Field: Distance from nearest, wellJV19'A&;_-D;stance from ---- -----Capacity_ foundatio5__:,_,-------------Distance to nearest lot line.__ ---------- Number of lines-----------/ �__ engfh of each line------- -'-V- ./-/------ Width of french------ _ J�� . -- f ----------------------- r Type of filter material----- Depth of filter-,�aterial__]�_ ------------Total length------3-0 yp C m ------------------------------ P;;40 Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line______________. (�i N 'mber of-pits----------------------Lining material-----------------------Size--Diameter--- --------------------Depth-------------------------I------- 1 Cesspool: Distance from nearest well-----------------Distance from foundation________._.____--_Lining Lining material-------------------------------------- El Size: Diameter.-----------------------_-- ------.Depth------------------ --- ------------ -- --------------Liquid Capacity-,--------------------------gals. Privy: Distance from nearest well---------------------------------I----------------Distance from nearest building------------------------------------------ El Distance to nearest lot line----_,--- ------------- Remodeling and/or repairing (describe):---------��7-----------'-_-------------------7--------- --------------------------------- ------------------ ------------------- ---------- ---- --- ------------------------------- ----------------------------------------- ----------------- ------------ -----------------------------------i-------------------------------------41--------------------------------- N.-A_ I -------------------- --------- ------------- ------------------------------------------ ------------------------------I-------------------------------- j---------m------------------------------------------------------ I hereby certify that I have prepared this application and that the work will-be done in accordance with San 1Ioaquin.�.Co_u_r_f_y,_ ordinances, State laws, and rules and r1gulafions,of the San Joaquin Local Health District. ------------;__0 (Signed)-- -------v--- - ---------------------------------- ---------------------------- ------------ - ----------------(Owner and 10 Con actor) By:-_--------------_- --------------- - (Plot plan, showing size'of lot, location of system in relation to wells, buildings, ef can be lai -------------------------------------------------------------------------------------- --------- - ------------ t2n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------- --- - - --------- --------- - ---------------------- ------- - D4T-E-- REVIEWED BY------- .......... ----------- ------- - - - - -------------- ---------------------------- DATk---A- BUILDINGPERMIT ISSUED---------------------- ------------------------------------------------------------------------ DA - Alte tj ns an4/1 gr recopjnendat' --------------- .71i-* 7, --------------- X -- --------------- ------------------------------------------------------------------------ ------------- ---------------- ---------------------------------- ------- -------- ----------------- ------------------------------------ ------- ------ -- --------------------------------- ---------t,- ------------ -------------------------- ------------------------------- ------ ------- ------------------------------------------ V. FINAL INSPECTION BY:-__ �ae Da - ----------- ---------------------------- ---------- F USAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sf`re6t--.. 300 West Oak Street 132 Sycamore Sfre814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revisea 1.57 F,P.Co.