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74K' APPLICATION FOR SANITATION PERMIT Permo. -- ----------� a *11 (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 ,.�-- �Y .__----- . ,�--�� --- - -/le Owners Name--------- u-�-------------------------- �- -- --- ----- ------------- -------------cam-- :�-��-_ Address Contractor's Name"- __ � ------------- ----'-` --• =---- C 12 ------------- .... Phcd Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: ---- ` ❑, Other 4 Number of bedrooms Number of baths -A--__- Lot size --- -------- -----------------------Water Supply. Public system Community system-E3 Private ®-'Depth ' to Water Table, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2---Hardpan ❑ Previous Application Made: Yes ❑ No 91---'New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: Flo septic tank or'cesspool permitted if public sewer is available within 200 feet. ! � ePT is nlc Distance from nearest well-__.---_----._--Distance from foundation--------------- Materia) No. of compartments ------------------Size--------•----------------------Liquid depth----------------------- Capacity Field: Distance from nearest well_-��--Distance from foundation-- _ �posal / .�--.-.Distance to nearest lot line_-/J_._.-- Number of lines-__.----"_-_-_ - Len Length of each•lirie.'- _ i� • g �� ----Width of trench"- _ ` ---------- Type of filter matenal - _-_-- Depth of filter material--/ ____: ----Total length---- _�"'�-- ��cf Seepage Pit- `Distance to near`ellst weII G[?_ !-_Distance from foundation_----1_pL� Number of pits---L--._"".-__---___Lining material- . -.Distance to nearest )ot line--- --. Size: Diameter- __- �� `v Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material_-_.---_----_ ❑ Size: Diameter-------------------------------------Depth___k------------------- -- - -----------I } Liquid CapacitY ------------------------gals. Privy: Distance from nearest wel) __ __ --------------Distance.from nearest building Distance to nearest lot line_________________� ___ _ - - .� _ g -------------- --- ----------------------------------- i ' ' Remodeling and/or repairing (describe)-------------------- �- ..; ---------------------- -----:..----•--••---------------------------•------------------------ - I ----- ----------- --------------------------------- -- - ------ I hereby rFif t t I have - -- - - --- •---- ------------------------------------------------------------ ------ ---------- --'-----•---------- ----------------------- Y y prepared th' pplication and the work will be done in accordance with San Joaquin County ordinances, S e_I andorule 'and regul s of the San Can- n]n Loc l Healt •dfricf, (Signed) ----- Plot len, showing size of lot, locatlo ' ( ract By:----------•---------- ---------••----- :.. f s ont or .. ------------ ---�---- , (T le) _____ ----------------- - P 9 n of system in.relation to ells"-buildings, etc., an be pl cad on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY--" I --------------------- --------------- ----------- -----------"------------------- DATE----------------------------- REVIEWED BY IT'_ISS_- � ------------------- DATE----�.----- t� ---- ------------ ----------- ----------- - �-==------------------- BUILDING PERMIT iSSIJED ---------- - ----------� --------------=—=-- -=----------------•-- ---------- DATE Alterationsand/or recommendations: -------------------------•--------------------- ---------- - ------------------ --------•----- --- • FINAL INSPECTION BY:----------- �-� +. ---------------------------- ": Date. ±1- •, = .c �%. t ----------------- SAN JOAQUlN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California F Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revised 1.57.F.P.CO.