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_ s APPLICATION FOR SANITATION PERMIT Permit No. .___1F..6....:....___. (Complete in Duplicate) Q Date Issued _____�j,�-.� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationi is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI Nj / - f D- --------- -` n -f- - Owner's Name l a�' { -� ---------------------------------- -- ��-f--•-0------------•:----------------------- -------------------------- ------------------ Phone C Address ... ---=5------ l�- d c n ----- Address7 Contractor's Name____--______ �` �S J- -------- 11f� - --��_ PhonP,�__e�----------------- _1 / Installation will serve: Residence ■ Apartment House L] Commercial E] Trai er Court ❑ Motel ❑ Other E]Number of living units: _ ._- Number of bedrooms __ Number of baths -_____ Lot size -_r d -X-14Ro . i Water Supply: Public system e Community system ❑ Private ❑ Depth to Wafer Table®ft. Character of soil to a depth of 3 feet: ( Sand ❑ Gravel [I x.Sandy Loam j] Clay Loam ❑. Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No M FHA/VA: Yes ❑ No ❑ 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________'_____Distance from foundation--------------------Material _______________..__________._.____-.._____.__. r�/V/C— No. of compartments------------- - ---- -----Size-=---- =----+,----------------Liquid depth-----;-------------------Capacity-------------------._.. Disposal Field: Distance from nearest weil_-_-------------Distance from foundation--------------------Distance to nearest lot line________________ Number of lines---j----------------------!-----Length of each line--------------------------_---Width of trench..................____---------- N Type of filter mate±iaL__-____-/_�__--_-. 3____f_Depth of filter material____._____n_____/____Tofal length____________________________ ______-- p, Seepage Pit: Distance to near st welfC1L' ,f-Dt i�aal ror� founds z n later - ar}r� to nearest {o# line __ Number of pitsbAliC---- Y �(. i� Depth Cesspool: Distance from nearest well________ _----- Distance from foundation---------------- ---Lining material-___.__------------._--______________- O C] Size: Diameter-------- ---------------:-----------Depth ----------------------------------------------------Liquid Capacity......----------------------gals. Privy: Distance from nearest well __._- ----I-_------------------_--------------Distance from nearest building---------------- rh n y IL�JI Distance to nearesfY�lot iime---------- ----------------------------------------------6------------------------------------------------------------------------------------ a Remodeling and/or repairing'(describe):- ..--------=- +-----I---------------------------•---------------------------------------------- ----------------{-------------------------------------- f L J.._ -------- ---------------------------------•---•----------------- -•----------•---•--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc to laws,fart>�-r I, r ulati ns of the Se' Joaquin Local �alth District. (Signe (Plot /Y `tel_? er and/or Contractor) By:------------------------------------------ ��'� � r�=r �� -(Titled �� f ---------------- - - ----------- (Plat plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- f-----------------------------' DATE�_ REVIEWEDBY----------------------------- ------ ------------------------- - ---- ------------------------------------------------ DATE---W BUILDING PERMIT ISSUED ------------- --------------=-------- - --------- --- DATE------ 3-----------------------•------- . .._ -- AI#er 'ons and/o recom endion :_______.__.______.°.___________•------------- --- -- -------------------------------------•- C - • � ---- -== --- -------------------------------- ---------------------------------- ----------------- y - , - r a ti 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 , Revises 1-57 F.P.CO_ f