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` APPLICATION FOR SANITATION PERMIT Permit No. 4 [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, JOB ADDRESS AND LOCATION_____________LIQ---------1�4--------�._____-_-_ -- -___._____---._______-_---.___-- ---_------------------------ i - _ Phone----------------•--.----- Owner's Namee4 e4 - � -- - Address---------------------45-4-9-------/��•---- �=---- .........S -----=---------------- Contractor's Name--------------------- 4 --------•---------------------- ---- ---------------- Phone----------------------------------- Installation will serve: Residence Y" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms __.�� Number of baths I____ Lot size ___ ��_- XI�__________________________ Water Supply: Public system Rr"�Commuriity system ❑ Private ❑ Depth to Water Table Character of.soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe Hardpan F]Previous Application Made: Yes [—] No New Construction: Yes [ENo ❑ FHA/VA: Yes ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: &,4T7�— 7&.6I w! No septic tank or'cesspool permitted if public sewer is available within 200,feet..), , s _. Septic Ta Distance from nearest well____ 1 __.__Distance from foundation__.�_C?________.Material____ 7�=------- ------ -. No. of compartments----------V-_------Size-_� -YN`____/V/---Liquid depth---------//-------------Capacity _ Dis os l Field: �� istance from nearest welL__.__ ___,Distance from foundation__ IJ_.______.Distance to nearest lot line___. __j____ �[ Number of lines-----------�_____-___________Length of each line----r-_Q------e!�,q----.Width of trench.____._.�- --------------------- ,. e Type of filter material-_ De th of filter material___ __ ------------- YP P �- Total length-------.,f_�Q --------------•---- Seepage Pit: Distance to nearest.well-----------------------Distance from foundation--------------------Distance to nearest lot line-----------_-_ \ ❑ Number of pits------=----------------Lining material------------------------Size: Diameter-----------------------Depth------------------ :------•--- Cesspool: Distance from nearest well________________Distance from foundation---------.__--------Lining material------------------------ _.____-_____. � Size: Diameter Depth;=-------------------------------------------------Liquid Capacity- ------------ - k als Privy: Distance from nearest well-----------------------------,;=w_._____.__-_.._Distance from nearest building-----------------------------.------------- [] Distance to nearest lot line ----- ----------------------- -- -------7----- ----------------------------------------------------- --------------------•----------- Ll ------- -\ Remodelingand or re airin desci ___ _ � � �_ � ,r -_, flan -��"- ---- -�- - � � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, Y 51ned ____._______________________(Owner and/or Contractor] i� BY: ------------------ ----'�-��------------ ------------------------------ -=• - — - Y Title} (Plot-}plarf;"showing size of lot, location,of iystem in.relation to wells, buildings, etc., carr-be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -------------------------------•----------------- DATE--------------- 4 REVIEWED BY -------------- ------ ---•---------------------------------------- DATE BUILDING PERMIT ISSUED-=---------------- -------------------------------- ------ DATE ----------------------------------------------- Alterations and/or recommendations: --------------------------------------------------------- --- -------------------------------------------- ----------- ------ -- - -- ---- • ---- --• ------------------•------- ------------------------------------------ ----------- '�t'-=•----- ------- � .._. .r -'fiY!!�4=F�--- ----G'/1 /e �__4:1-��---__ft! --._.ft. ,d- ----•- ----€-r.1.Ge_�!__E� ....-•F`_�_.'Erb•*�-�------- ------------- ----- - -- --�'-,JL4'[.J--Z•f.�••2<--r-----��'--� ----�- ---- - ---------------------------- --------------------------------------- -------------------- FINAL INSPECTION BY:---------- ----- •- ------------- Date------ 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 Revises 1.57 F.P.CO.