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APPLICATION FOP, SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued scribed. Application is hereby made to the San Joaquin Local Health District for a permit to constgct and install the work herein described. This apili fi ' de in compliance with County Ordinance No. 549. �;ca ion is ma .14 .* " - _?------- --- --- ------ --------------- ------ -------- JO�ADDRESS ANrCATIO ------- ------- --- 10. 5 Phone------------------------------------ Address . hone------------------------------------ -------------------------------- ----------- Owners Name ----- ---------------------------------------------------------------- - ------------------------------------------------------ Addres. Phone----------------------------------- --- -------/-------- - ------------------------------------------------------- Contractor's Name-----'--- .........I Commercial E] Trailer Court E] Motel [I Other El Installation will serve. Residence Apartment House El - Lot size ------ ----------------------- Number of living units: Number of bedrooms _-5- Number of baths ----f_ p Water Supply: Public system E] Community system Y',Private A-v*f,fh to Wafer Table "ft.Clay Loam 0 Clay 0 Nodobe E] Hardpan F] Character of soil to a depth of 3 feet: Sand El Gravel* Sandy Loam FHA/VA. YesX El Previous Application Made; Yes ❑ No 0 New Construction: Yes gj� No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well__4� Ma 1 1 .12-------Distan from found +;on----/,9--------- ------------------------------------------------- Sepfic Tank: Size-_-V T _Liquid depth-------------- -------Capacity-/-?-jD -------- No. of compartments-----'Jo ---------- line--- Jafion Dista, t nosrest lot nearest well_ Q-------Distance from foun(— Disposal Field: Distance from -------------- ---- -----------------Length of each ------�071 --- Number of line --- ----------� ;11 material_1-e-- ]thtl'� 1A ateriaI__,Tjj_ __4!,4_Depth of filter _44>- --------Total lengthy-Type of filter m' Seepage Pit; Distance to'nearest well----------------------Distance from foundation--------------------Distance to Number of pits----------------------Lining matorial-----------------------Size:'Diameter------------------------Depth------------------------------------' ❑ ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------city,,.------------ _F� Size: Diameter-------------------------------------Depth-------------------------------------------------------Ucluid,,Capa_ El � -— --tAi- -- I stance from nearest building------------------------------------------ P--privy: Distance from+rearesf well_----._.____----_____ Di ---------------------------------------- F1 Distance to nearest lot Iane____.- -_--------------- --------------------- ---------------------------------------------------- Remodeling and'/or repairing (describe):------------------------------------------ ------------------------------------ -I----I------------I------ --I----------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ----------------- -----------------------------:--------------------------------------------------------- ------------------------------------------------------------------I---------------------I---------------------------------------- ----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aw�-11— rulesand-regulations of the San Joaquin Local Health District. ____�Ial.l IM�01. the --------------7-(Owner and/or Contractor) (Signed)__-------- ...... -- ---- By:_-----------------------I----------------------------------- -------------------------------------------------------------------(Title)-------------------- - - side].- ------------------------ -- (Plot plan, showing SiZG of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY -------------------------------------------------- APPLICATION ACCEPTED BY--I----------------------------- ----------------------------- DATE----------DATE---------- ---------------- REVIEWED BY------ ------------------------------- ------------ -------------------------- DATE-------- ------------ ------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------04- -------- -- ---- --------- -------------------------------------------------------------- '0 ---------------------------------- Alterations and/or recommendations:______________- -;.......... -------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------ -------------------------------------------------------------------------------- ---------------------11---------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------------------------------- --------------------------- --------------- ----------------------------------------- --------------------I -----------------7---------------------------------------------------------------------------------------------- -------------------------------- - ------------------------------------------------------------------- --------------- --- ----' - Date---------- -------------- FINAL INSPECTION BY:------_I----- ----- - -------- ------------ --- I)d& SAN JOAQUIN LOCAL HEALTH DISTRICT Soo West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California. Lodi, California Manteca, California y, ES-9-2M - Revised 1-57 FY-CO.