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&/�M 41� b APPLICATION FOR SANITATION PERMIT Permit No. .-- 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. j-- OL(O_6 ( I JOB ADDRESS AND LOCAATION----°-�--~-��_- -- �` �1`. = ------ ---t--�i�„,f_e l -------------------------------- Owner's Name---• �/�/ �i /' l�/i Phone Address----------e1,t1 ----------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- Con#rector's Name-- tf - �------------------------------------- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other Z�— Number of living units: Number of bedrooms __-!rT- Number of baths _i-_ Lot size � _---__---________ Water Supply: Public system E] Community system El Private D � epth to Water Table _ w tt. i Pv. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ®/flay ❑_.Adobe❑ Hardpan [_Jt 1 Previous Application Made: Yes ❑ No P21--New Construction: Yes �10 ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w II _ _��Distdnce rom foundation____f49_______.Mat rial_j&, p �� - ��iL . tom' �� ----��- ---=----------- �r No. of compartments---r_�_______________ 61_ _ X 4 0______Liquid depth_-{_ Capacity____,F Size = �i Disposal Field: f Distance from nearest wei{1i94P_tD;stance from foundation__-__/X_ __:Distance to nearest lot I`�_�, . - Number of lines ------ Length of each line_____ ___-� Width of trench____ ___________________ Type of filter materialepth of filter material----- -----------Total length_.: ___-------------------------- +Seepage Pit: Distance to nearest/well_ _ ____Distance• om ,,#o ndation: ��_--Dista c to nearest lot link .-. Dumber of pits._.,/__ oe °.________s_Lining material ---Size: Diameter__ __ Deptn___.. ________ _____ Cesspool: Distance from nearest well------------T"_"Distance from foundation-------------_------Lining material--------------------------------------- ❑ p Size: Diameter--------;_4----------- •----------Depth------------------------------ -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------____-;____________________ _Distance from nearest building.' __________- x -------- g. = ... Distance to nearest lot line - '-�------------{------- -•----------------------------- -- ��------------------------ Remodeling and/or repairing (describe):'------------- -- - - --- - _ ---- r_ ----_---___-- 'y +. ._,�y-------- _ r _ % _.�?__ _ .._ ,. 1 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. (Signed) - '� - 6 -------------------- - Contractor) By:------------------------------ ` - ........... ------------- (Plot --- - , TitfeP } 1 - ( (Plot plan, showing size of [of, location of stem in.relation to wells, buildings, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------ ------------------------------------------------------ DATE 1 --------------------------- REVIEWED BY-------------------------------------------------• - DATE ' ----------------------------------------- ---------- ----- --------------------------------------- BUILDINGPERMIT ISSUED------------------------------- I------------------------------------------------------------------- DATE---------------- - ----------- Alterat'JOBSand/or recommendations ; `---- ---------------------------------- ------------------•-------------------•--------------------------- = " ----------- � � --- --- - --- --- -------------- .---��e'[:- -' cwc t"". - -------- - - --------------------- -------------------- ------------- -- ------------------------------------------ -------------------------------- --------------------------------- -- --------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------ FINAL INSPECTION BY:-.------- - -------------- ------------ Date-- �- ----------------- ...1---------------------------------------------- SAN`JOAQUIN LOCAL REALTH DISTRICT 130 South American Street 300 West Oak.Street 132 Sycamore'Street 7 ! lv�\:� $141 North "C" Street Stockton, California Lodi, Califorffid '""' - _ Manteca, California Tracy, California ES=9-2M Revised 1-57 F.P.CO-