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F7. APPLICATION FOR SANITATION PERMIT Permit No. 13 - (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 L CATION__ -------------- 7 Z - "�WW741' � d3�—QS ,'. ----- --- � . Owner's Name -- _. �''/ CQ � :�1-- Ph� a� �--' Address y�� p 1L� ` u- �C• - ------ - -- �'-2------ --- ---s. -- --- N --v P 73-2—Y-3 Z Contract is Name------- !�. ✓ honed Installation will serve: Residence.A Apartment House ❑ -• Commercial C] Trailer Court ❑ Motel ❑ Other ❑ r 4 Number of living units: --1----- Number of bedrooms --- Number of baths -4---- Lot size -_ -f _�r7_�_-----__________________ J i Water Supply: Public system ❑ Community system ❑ Private P Depth to Water Table _ ____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam VL Clay Loam ❑ Clay [❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No,K New Construction: Yes ❑ No Qf FHA/VA: Yes ❑ Noj:N ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic-Tank:'- Distance from nearest well__ Qistance.from ___—_____________ No. of compartments--------- ---------------Size--------------------------------Liquid depth-------------------------.Capacity----------------------- Is"N Disp al FielcS! Distance from nearest well__- ____.Distance from foundation Distance to nearest lot line, p_---.__. 0)�J Number of lines_______________ _________--___Length of each line Number of trench-----, __._______________ Type of filter Depth of filter material---1g__--------Total length-__/0-0__ ______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------------Distance to nearest lot line_.-�__--_--___-__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- .f Cesspool: Distance from nearest well_________________Distance from foundation--------------.----.Lining material--------------- ----------_-_________ ❑ Size: Diameter------- -------------------- -------Depth---------------------------------------:-.-----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_-----------------------------------------------Distance from nearest building---------------------------------------_-. ❑ Distance to nearest lot line--------- ---------------- _------------------------------------------------------------------------------------------------------------------- Remodeling and repairing (describe} ------- ----------------- tll-S]JU ------= ��a p ` LU -------------------------------------------------------•--•----------------------=-----•------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------=--------•-••----••--------------------------------------------------------------------=--------------------------------------------------------- --------- ------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, nd rules and a ulatio s of the San Joaquin Local Health District. r (Signed) ______Owner and/or Contractor By:----------------------------------------------------- ------------------------------------------------------------------------------(Title)--------------------------------------------- -- --------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on-rev - + FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY-- _ ---- BY ------------==-------------------------- DATE-------------------------------------•------•--------------- BUILDING PERMIT ISSUED------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations-------- 4------ -------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- FINAL INSPEC --- --- ---------- Date------7-/406/7 - ----------------------------------------------- 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 . Revised 1-57 F.P.CO. a