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/ a APPLICATION FOR SANITATION PERMIT Permit No. .lS1_ [Complete in Duplicate) i Date Issued Application is hereby made to the San Joaquin Local Health District for ermit to construct and install the work es This application is made in compliance with County Ordinance N ��3herein described.cribed, OB ADDRESLAND LO --- /a--4--- ----.�Owner's Na X" - - - - .__-- t �c --- ------------ Phone -- 9 Contractor's 'Name------ ------- 1 ki .?� Z7 ------ fir- ._ - ---•--------- Installation will serve: Residence � ---- � ------- -----------�-------- -•--- Phons�-/1r----ff"__2 ,-, �partment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units.- --�_._ Number of bedrooms .__ iQ` ❑. Other umber of baths ___j_ t size ___--�-- Water Supply: Public s stem I Y ❑ Community system ❑ Private jg_,@epth to Water Table : ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 4 Previous Application Made: Yes ❑ No ��, Construction: Yeso (] FHA/VA: Yes 4�— !o ❑ x TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) a r `,, .Ltic T Distance from r nearesr well � - �� /' _Distance from foundation -_-------Materia------------------------------. � No. of compartments-.' '__---_--"_--Size -N<-�_.9__:---Liquid depth----- .61 0--------capacity_.---- - Disposal Feld: Distance from nearest well � ? y -- P/ �____.Distan e rom foundation--Z-4P---.-.-- fo neares __ _�______ Number of fines!. __ . -----Length of each line_ ,3'- -_ ' Width of trench Depth of fitter material- � Type of filter material- -- =: -- ---------- Seepage Pit: length------------------- Seepage Pit: Distance to nearest well_-'_____--£____----`-Distance from foundation_" ------------- Number j o� --.Distance to nearest lot line---------_-- t ❑ of pits.- Distance--, Linirig material--------------------- SizeDiameter - Depth ------------------- Cess ooL• -__ ❑P Distance from nearest well_______________ Distance from foundation- `---------.-------Lining material__-.____._--_____.___--- Size: Diameter__~i---------------------------------Depth------------------------------------- -------------------Liquid Capacity -------- gals. rivY: Distance from nearest well _---_---- ,:_- "-__------- ------ --Distance from nearest building----, ❑ Distance-to nearest lot line ---------------------- ------------- k -- ---------- ------------ -- Remodeling and/or repairing fdescribej-------------------------------- ------------------------------------- } ----------------------------------------- g.,.. - ----'------------ --•---------- --- 3 Pl - AP --------------------------------------•--------•---------------------------------- I hereby certify that I have prepared ared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules andregulations of the an Joaquin Local Health District. - _ _. C t t ) --------------- --- --------------- -- ----------(Title)-----------•-- (Plot plan, showing size of lot, location of system in relation wet s, buildins, etc„ can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------- __- ------------ DATE-----/-�-�-8---�------------ REVIEWED BY ------------------------- -------------- --- ------ DATE-PERMIT ISSUED F ---------------------------- DATE Alterations and/or recommendations:____/-_-19- -_-- ------------------------------------------------------•--- -------------------------------------------- ------------------------------------------ _ "i0� .-_________ 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, Celifornie Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.CO.