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l Permit No. _______..... t�,'�`�,��a•�u APPLICATION FOR SANITATION PERMIT ��•--------- (Complete in Duplicate) r V, 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--------- ------- yMQle�-- - ------,-.-�----4-------�- ---�- O } -- ----- ------ - -- Phone- --------- ; -------- Owner's Name---------- i Address-----------------�rzo-------- ...`./ . ------------------ -- ------------------ Name----f = =-------?-----/,`��/5� d-�o�s-----��/�, F ---------------•---- Phone�_�_. xA J. Installation will serve: Residence ❑ Apartment House E] Commercial K Trailer Court ❑ Motel El Other El Number of living units: !( 4�Nlumber of bedroom_ s 4P Number of baths __ __ Lot size _____ -----------_________________ Water Supply: Public system 'Corr'm-unity—system❑•Private❑—Depfh-fo Watei Table (to ft. "" Character of soil to a depth of 3 feet:' Sand E] Gravel ❑ Sandy Loam El ClayLoam•❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes , No ❑ FHA/VA,. Yes E] No Y} TYPE OF INSTALLATION AND SPECIFICATIONS: Y# No septic tank or`cess ool perrhitted if public sewer is available within 200 feet.) '. Septic Tank: Distance from nearest well_,MOII�:Distance from foundation- Se --------Material ___!�� ____________________ No, of com artments -� s �1 p .� 1 Size 1�O�e 1_:_.liquid de h =Capacity----;F00 f ` i " i 0-� Disposal Field: Distance from nearest,weil_-_/VI11 .Distance from foundation ____ __ ________Distance to nearest lot lin�e� �_______. Number of lines_________ ___ __ Length of each line________ ---:Width of trench__._ Type of filter material__-- 1RFGZ_'___Depth of filter material___l4_____________Total length_-__.-,I_4________---_•___ ___________- Seepa a plc: Distance to nearest well__ _ _Distance f'om foundation__ 're-/'-.Distance to nearest lot line---- Number of pits- r ❑ '. ----Depth_____..,-_4- -------------DQ\^)l._______ Cesspool: Dto frorn nearest well5s ce from foundation ------------- ------------------- -' - -----------------Liquid Capacty---------------------- gals.' Sz� Diameter _. Depth ,, `t\ Privy: Distance from nearest well------------------ __________________-------------- from nearest buifdlng-------------------------------------------- E] Distance to nearest lot line __--_'._______.__ w '"' �+ -------------- -. --ell g •�o e-=p---.--g (describe): des )-------------=----------- ----�.-----------------=----------------------------------------•--------• ---------:----------------___-- •=----------�' Remodeling and ar r6airin describe ______________________ ---- -------------------------- ----------------------------------------------------------•-•---------------------------- T f 1 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 laws,`an ules and regulations of the San Joaquin Local Health District. {Si ned g ) 'ir - - --- -------------------------- (Owner and/or Contracts). BY� -- - -- -- i -- -- - - --- ----------•(Title)------ = (Plot plan, showing size of lot, ocation of sys+em in re ion to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY------------- - ---------- - ---------------------------------------------•---------------------DATE_----- --- --------------------- -- -----------. 7 REVIEWED BY-----------------=----- ---- ------ - ---- - - ------, --------------------------------------------------------- DATE. DATE_-.-____ BUILDINGPERMIT ISSUED------------------- ---- - ---------------------------------- ------------------------------- ------------ Alterations and/or recom�mrendations: - -------------- -- ------• -------------- ------ -------_----- ------- r ------.� ' 4 -�' ,1--./.rta 14 •�- s- -t ,lam. ----- - -�-r- �-A-alu-----------_7. 4 — ---------- ------------------ - +� ��# - . ----------- `- = ---------- f -_! - /.!3 RC 1 = . FINAL INSPECTION- BY::____-% - `- - ..._. - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 Horth ••C•• Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M , Revised 1-57 FRCO. i.