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;4 APPLICATION FOR SANITATION PERMIT Permit No. hfI4�_-_ (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 inc ompliancetwith County Ordinance No. 549. JOB ADDRESS AND LOCATION.__10? D_ __�I /I, , G" Owners Name �'1 _ L�_ Q+ -------------------- = xi/ - Phone Address_ � �� - --_ ✓---------------------------a---- ------------------ Contractor s Name------------- -----------------------------------------------=----------------- I Phone----------------------------------- f Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [] Motel p Other Number of livingunits- __ __.._ Number of bedrooms ❑ / , � __- Number of baths`y. Lot size � Water Supply: Public system Cl Community system Private ❑ Depth to Water Table*49_�ft. Character of soil to a depth of 3 feet: -Sand Ej Gravel [] Sandy Loam ❑ Clay Loam Clay ❑ Adobe I] Hardpan ❑ 09 Previous Application Made: Yes ❑ No PT'- New Construction: Yes @�J`No ❑ FHA/VA: Yes ®-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) N Septic-Tank:. _ Distance-from nearest, Distance Distance f.om-foundation_ ._______.Mataial�4__.��.�r-. --___--_: .� I No, of compartments_-__ ._.______ X-Y __.___Liquid depth---'Jr- cCapacity..__ QQ______ -------- V V147. Disposal Field: Distance from nearest weI�QQ.__�_'_Distance from foundation---�i�_ ----.Distance to nearest of line--- Number of lines----- -_-_-, * french---- -,. ---------- + --- - ------------- Length of each line---ss�___----l� Width of --- ,__-_-- ---------- I)F Type of filter material of filter maferial___ _______Total length-___ _ } �. i .4 � Seepage Pit: Distance to nearest well /l�� Tt--Distance f�r}m fou dation---�i-_.---.-..D-s a_ap to nearest lot fine_- Number of pits__-_1--.________-Lining material_-�A%.�_Size: Diameter__) Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material_.___---------______________________- ❑ Size: Diameter------------------- ------Depth----------------------------------------- --------.-Liquid Capacity-------------------------.---gals. Privy: Distance from nearest well____-._.__.______.__________________________-Distance from nearest building ❑ Distance to nearest lot lire-------------------=---------------------- --------------=---- Remodeling and/or repairing (describe):------- �f'�J-- s�__ �' ' -------------------•-----------------------------------•--- _ ------ ------------------------------------------------------------------ --------`---------------------- --------j---••---------------------------=------------------------------- ---------------------------------- -------------------------------------------------------->--------------•------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Caunty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned g )-•----------------/6494P--------- ��t�_,�t.��-/-�---- ---'�----------------------------------------------------- -(Owner aad/Qr Contractor) BY: ► �*' -----------------------------(Title)- . ------------------------ (Piot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY µ»-- APPLICATION ACCEPTED BY--- DATE r REVIEWEDBY-------------=------------------------------------------------------------------------------ -------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations____________________ ---------------------------------------------------•------------------ ----------------------------------------------- --------------------------------------•---------------•-- --------------------------------- I -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------•---------- -------------------------- ----------------------------------------------------------- --------------------------------------- ----- - ---------- ----- ------------------------------ ------ ---------------- --------------------- 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-4-2M Revised 1.57 F.P.CO.