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'APPLICATION FOR SANITATION PERMIT Permit No. ----- __372_. (Complete in Duplicate} Date Issued _-1- e Application is hereby made to the San Joaquin Lo Eiea4}h-i�list �#fer-a per-raa-.io con truct and install the work herein described This application is made in compliance ounty Ordinance No.X549. GIle JOB ADDRESS A ILOCATIONn-- - T Y - ---------------- - -- -- Owner's Name -- -[✓v �l- Phone 1 Address _- �- ------- ----------------------------- � `� = '� / f�,, , ------------------ •-•-----•----- --------•-------•--- Contractor's Name ..{ ! -� ��" 4 - [. -- --- --- - Phone I Installation will serve: Residence FQ�Apartment House ❑ (Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .l 1 � _ -------------------------- Number of living units: _- _-- umber of bedrooms -_-=_-- Number of baths._-__-_--,hot,size _ -,---_ 1 Water Supply: Public system V Community system ElPrivate E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ,y Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ t Previous Application Made: Yes ❑ No New Construction: Yes E] No E] FHA/VA: Yes �No El TYPE OF INSTALLATION jAND SPECIFICATIONS: Ii 4r(Na septic tank or cess`poo�l permitted ipublic sewer is available within 200 fe�e}t,} ( r - I !(/ Material_ Septic •ank: Distance from nearest well_----- �E}istance from foundation__------- I No. of com-partments�= &--�---�----f-�Size Liquid depth CapacityQ "W� .istance from foundationt-0-*i'"'"- Distance to nearest lot line----,, Dispos k Field: Distance r_o_m nearest well_ __ kIf------ ` Number of lines_-�:_-_---._____ --- Length of each line _47a_ .Width of trench.- 4 41-1 Ft. Y Type or filter y matleri i. - ,--- epth of filter material--------i1- q------Total length--}-------------�- --- ------------ Seepage Pit: Distance to nearest well------- --------------Distance from foundation-------------------Distance to nearest lot line----------------- El Number of�pits__ �---------------- Lining material-----------------------Size: Diameter------------------- D .--- epth------------------------------- -- Cesspool: Distance from nearest well---------------Distance from foundation__ -----------.-----Lining material-_---------. ------------_-___-_----. Size: Diameter------------------------- ----- --------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-j--------------------------_.---------- Distance,.from.nearest buildin � - ❑ Distance to nearest lot line----------------------------------------------- ---------------------------------------------------.---------------------------------------- ------------------------------------ Remodre a----------------------------------------- I rnq�iii416cribe -------------------------- --------------------------------------------------------- --------------- d/ ACV ` --- ------------------------------------ ------------------------------------------------------------------------------------------- ------• -� - ---------- --------—---------- - -------------------P--rp------------------pP----------------------------------------------- q 1 herebycertifythat I have re ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 5i rsed 1 ------------------------------------------------------------------- (Owner and/or Contractor) ( 9 } -• --- Plot tan, shoe f, o , ocati 1 $Y� -- ` (Title} ------------------ ( p g, � =o_ n�of�system i•snrelafion�to.,Wells.,buildi19s,4etc 2can.be placed on reverse side}. 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --------------------------------------------------- i _ _ DATE REVIEWED BY-------------------------- -=---- --------- ----------------------"------------------------------------ DATE---9 ------------------------------- BUILDINGPERMIT ISSUED-----I------------------------------- ------------------------4---------------------------------- DATE----- ----------------•--- Alterations and/or recommendations: . = _'77 n -------------------------- ------------•--------------•---------------------------------------------------; ---------- ----------------------------------------•----- ' -------------------------------------------------------- ---------------------------------------------- -----------------------------------------------------•- i! `. --------=---- ----------------------------------------------------------------------------- ------- --------------- -----------r----------------------- FINAL INSPECTION BY:--------- --------- Date ------/------- w �7 --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California i ES-4-2M Rev;sec,1-57 F.P.CO-