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. APPLICATION FOR SANITATION PERMIT �, � ermi# No. .�_?__3-/----- 1 (Complete iW Duplicate) 2 / eh r Dat�ell �dd /Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thedescri ed. This application is made in compliance with Count Ordinance No. 549. - -» .. .fid, -'� - ------�/Ra !-,R `' r,�-L. �l,* JOB ADDRESS A LO ATI N �n Owner's Name ----------- �� ( !�-W-,4,11)---------------------------------- Phone-------------------...a--------•--- Address------`�` `-�--�-------------- ----- ... ----------.... •--------------- ----------•-----------------------------.--...horiee �� ---- Contractor's Name________________ ___- _ Phon .. . .__.__ � Installation will serve: Residence Rj--"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 11 Number of living units: J___ Number of bedrooms -9�- Number of baths -A-- Lot size ------------------------------------------------ Water Supply: Public system ❑ Community system p- Private ❑ _Depth to Wafer Table 40- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No!g?""New Construction: Yes ❑ No R---'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' /" u (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) .,! e is nig: Disfance from nearest well___ P_____Distance-from oundation__________________-Maternal___ _h _f _ -____� No. of compartments----------------+l-- Size -r- -••-------Liquid depth--------- ------------Capacity--�fl'6-------- Disposal Field: Distance from nearest well_ �_r___tDistance from foundation__ ' --------Distance to nearest lot line__��__--_ �� Number of lines-------✓_________..____.__ Length of each line__-----�40Ki--r___.Width of trench-___�_51_�--__�'._______... Type of filter material._ .__ Depth of filter material ___l_ ________Total length-----t.n______________--:________.___ Seepage PiDistance to nearest well f______`""_____Disfance om fvundation___.___Q____._..�tanc to nearest lot line___ _____________ Number of pits._ ___________--._Lining material_ __ ------Size: Diameter____. ___8_r _____.Depth_-_ - ��___�!_._________ _ 1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------_____._____"__-________ ❑ Size: Diameter----- --------------:------------DepthA-----------•-----------------------------------.-Liqu;d Capacity----------------------------gals. r _____________Distance from nearest building Privy: Distance from nearest well---------------•------"_--�:-__---- g------------------ �-------_----- ❑ Distance to nearest lot line--------__---------------------------------------------- " _ ! - ibe)_________rl 1I Remodeling and/or repairing (descr _--_ - Y y ' -------- ! c \ -----------------••---------------------------------------•------'----------------•------- -------------------------------------------------- ---------'----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules and regulations of the San Joaquin Local Health District, i 4 Owner and/or Contra i (Signed) ------------- - ---------- - - - { / Contractor) - -------- -------- ------ il BY:------------------------------------------ - /_// �f- Trtle �� f/ '• , ( � 1 (Piat.plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE I- ------ REVIEWED BY--------------------------------- --- --------------------------------------------------------------------------------- DATE +° -----------------1-.------.---!i- PERMITISSUED--------------------------------------------------------------•--------------------------------------- DATE---------W" ,'---------------------------------------•_----- Alterations and/or recommendations------------------------------------------------------------------------ � II --------------------------•------------------------•----------------------------------------- -----------------------------------•--------------------- ----•----•----- -- '-•----.......------- II ------------------- -------------- ---- ••------------------- --------- ------------------------------I------------------------------------------------------------------ II n 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, California Lodi, California ' Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO. ii