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r APPLICATIOt4 FOR SANITATION PERMIT Permit No. .: (Complete in Duplicate) s 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 LOCATION--.--=----,�,1 -----Zl ------- E-_ _� T ------/c—_2!4---------------------------------------- Owners Name----'--=-----------'--4--1--------- =----- ------------------------------------------ ----------- Phone--- -'- --- - - --• - - Address------------------ -------1='Q1__,1� ----------------------------------------------------I-------------------------------------------------------- Contractor's Name-----------------•------------• �---IW_4' ,e------------- _7-Z) �� - -- '�.T GTS Phone � _ k Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , �y A6)25 r Number of living units: ^__.'__.Number of bedrooms --------- Number of baths _ _ Lot size -------/�0_1_�, `__ _____ _ ______________ Water Supply:V"Public'"system ❑" Community system ❑"Private'[?("Depth to Water Table #S_,ft. Character of soil to a Idepth of 3 feet: Sand Gravel ❑ San'dy'Loam 0 Application Made: Yes 0 No Now lay Loam Clay Adobe Hardpan El A li [ NConstruction: Yes L]No FHA/VA: Yes Clay 0 E TYPE'OF INSTALLATION AND SPECIFICATIONS: t _r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o �ac.}e+ 41> Septic ank: Distance from nearest we Distance_fr�.foundation___-� _-____.Mat r�al_ _rClh___ No. of.compartments__.___,_-- _:____ Size___X_As__-x_-_�Liquid de th_____ rj q p . ' Capacity F� Dispos 'Field: Distance from;nearest -well ____-Distance from foundation_____ -- - -_'___Distance to nearest lot line____ Number of lines`_____---___f.._--_ ____:___'Length of each line:.-_________-��5-_________-Width of trench._____-__"___:______ g Type of filter material_____.... Depth of filter material____ �f'.____Total length___-____-_:_7�___`____________________ ,,..w. .•, _ .,. ....�..._. _. =.. ... ,•. .v _... .fir Seeps Pit: Distance to nearest well_____ ____Distance rom foyndation___,/Cl__________-D,stanc.e to nearest lot line__C?_____.__ Number• of pits------- ------------Lining material/L=UC.ff-f--'�. rte Diameter-------s - -----.Depth--'-------r�_ ------------- Cesspool: _ Distance from nearest'well---------------- Distance from foundation-------------------=Lining material----------------------------------___. Li uid Ca acit Y SiDiameter Diameter---- -1- ------'------: Priv 3 � Depth------------------------------------------------------ q p Y gals. ' Distancer rom nearest well__________. � Distance from nearest buYdin ❑ Distance to nearest lot line_"- ::`___^___.' --- - Remodelingand/or repairing (describe)-------------------------- -------=------------------------------------------------------------------•----------------------------=--------------------- f Ca --------------------------------------------------------------------•---------- ---------------------- 1 ----------------•--------=-----------------•- •---------------------=--- ------------- 9 ,� ----------------------------------------------------------------------------------------------------•--- ----------------------------------------- '- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; State I , and rules and re ul tions of the San Joaquin Lopa alth District. r �- Si ned ------ -- ---- --= Y _ {Owner and/or Contractor ( g ) ---------- - - By---------------- -----••------------------------•i--------------------------------------------- --------------------------- (Title) (Plot plan, showing size of lot,location of system in relation to wells, buildings,.etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ` - ------------------------------------------------- -------- DATE---------- ---------------------------- REVIEWED BY---------------------------------------k-- ------------ =----=----- --------------------------------- DATE-- _ ----------------•--------------------- i BUILDING PERMIT ISSUED----------------------------- `� DATE----_--_-- _f ----------- Alterations and/or recommendations:-•------- - ------ ------------------- ------------ --------------------------- ----------------- E . . 1 ------------ h --------=--- --------fid`-`�� } t. s� ------ . ° '`--------------------------------------------------- ------------------ --------------------------------.----:--------------------:--------- --9:_- `"' ;= FINAL INSPECTION BY::-_____:.- x Date_. } : SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West'Oak Street 132 Sycamore Street 814 North "C" Street r Stockton California Lodi, California Manteca, California Tracy, California /iso • �� E5-9-2M Revises 1-57 F.P.CO.