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E APPLICATION FG-.. SANITATION PERMIT Permit No.-_Zd.3_ (Complete in Duplicate) S Y 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---------�-`� -3" 7! ------------- ---. ---- . Owners Name------- �` = _k �� `=_ 1 '±P�"' i Phone---?V---�(?�< ., Address - ffv%..-_ -I Y' -- -----------• -------------------------------------------------------------------------------------- Contractor's Name--4-/:---- '--------- ----- Sr-/. S ✓/C .-------. Phone----•---•--•------------•-•--- w .'L _' Installation will serve: I Residence ❑ 'Apartment House E] ' Commercial ❑~ Trailer Court ❑ Motel Other E] Number of living units:+ INumber of bedrooms -------- Number of baths -------- Lot size ----- ------------------------ Water Supply: Public system 01,-<ommunity system ❑ Private ❑ 'Depth to Water Table' 0-_ ft. Character of soil to a depth of.3,fee.f:'Sand ❑ ' Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe. Iardpan ❑ Previous Application Made: Yes Q-"No ❑ New'Construction: Yes Q�o ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . #-,(-No septic fank or'cesspool permiffed if public sewer is available within 200 feet.) t Septic T nk: Distance from nearest weil_-_-_-------._-Distance from foundation-------------------.Materiai-_--.----.--------.---------_----- "_------------- .. L No!'of compartments---------------------------Size---------------- -------------_Liquid de th------=-:=-"""- "-------Capacity Disposal Field: Distance from nearest welt_- Distance from foundation--------------------Distance.`to nearest lot line."""__"-""-"_""_. ` 'r 4 Number of line -----------------------------------Length of each line':----------------------------Width,of trench----------------------------------- 4 Type of filter material-"---------------------Depth of filter material::-"---_--" -_-r Total length__._"_""_""_""""""""__""_""_""""__."____.. r {V P ' T' ""9 Distance from undation-"" _ ---__-.-..Distan veto. nearest lot fine_�A-------__-- ai_-_, : Size: Diameter" �j Depth""""_.`" Seepage Distance to nearest well__"-_". ----- Number of its. = Linin mpt f`' Y 7z------- ---------------- `7 A Cesspool: Distance from nearest well-----------------Distance fr oundation._.-_------- >Lining'material__-_-------_-------_____-__-----_--_ ❑ Size: Diameter-------------------------;------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest b'wilding----,.--�,�--------------.-- -.--- ❑ Distance to nearest lot line i ---[�Liilcling Remodeling and/or repairing (describ`e):_-_-" -"----- --- _ -"- _ ----- =-------------- 'S ,z,. - - -- --xfif = ----- -6,4At ------------------------------- ------------ ---------------------------------------- -----------------------------1-0 -------- ` -=------------------------------------------...-------------------------------------------- --- ------------------------ ---------- --------------- ------------------------------------------------------------`------------------------------------------------ �.� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County' ordinances, Stat law , and rules aAd're ulations of the San Joaquin Local Healfh District. (Signed)---- ' " --2-r _ �• P ----------------------F-------------:---------------------------------(Owner and/or--C---o--n--f-r-a--c-t--o--r) By:---------------- ------------------------------------------------ ------------------------r'------;--------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATE-------- -_z.y E REVIEWED BY.. ` ---------------------------- ----------------"PATE------------- BUILDING PERMIT ISSUED---------- ` ------- --------------------------------------------4_J-------- ------ DATE-.- •--------- i Altettrations and/or refcomme dations-----------------------------------------------------------------------------------------------------------•---------------------------------------------------- f -----------. l "�t1.�Gc►.. �o�. � �'`"''.�'u�w� ,=-------------- --- ------------ ---------{ - =1 ' ' -----------------------------------•----------•------------•--•-----------------------------------------------•------..:..-------------------------"•-"----•-------•-----------------------•------•---------------._...---- ----------------------------- ----- -------------------------------------- ------------ FINAL INSPECTION BY:- - - -4ll&------ ------------}---------- Date---- - ------1-�-- � -----� - SAN JOAQUIN LOCAL. HEALTHYDISTR'ICT 130 South American.Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f ES-9-2M Revised 1-57 F.P.CO.