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APPLICATION FOR SANITATION PERMIT Permit No, !_. _____ 1 )1� (Complete in Duplicate) l t Date Issued .--1___ Application is hereby made`to the San Joaquin Local He I or a permit to construct and install the work herein,described. This application is made in compliance with iop&"th e No. 549. JOB ADDRESS AND LOCATION ._.... .. _ :___ .... ---------------- Owner's Name------ -- � ._ Phone - ----••--- - ----- Address. ..r�. i l.�f = I FContractor's Name------ --------------------------------------------------------------------------=--- Phone...... -------------------------- Installation will serve: Residence ®impartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: _f--- plumber of bedrooms -AR.- Number of baths --/-- Lot size _fie-AW---/,�.---__----------------- Water Supply: Public system ❑ Community system Private 171 Depth to Water 'Table ;P..7ft. Character of soil to a depfl��of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe lardpan ❑ Previous Application Made:,iYes ❑ No New Construction: Yes [�Vo ❑ FNA/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 welLxM/___Distance from`f/oundation_��- --_-.M t r al_-- _ ._ -- -__.-.... ompartments---VF -------------- --Si?� ---' �` -- ---Liquid dept , Capacity----��--p-- Dis Disposal Field: Distance No, o c p from nearest well))&� Distance from foundation_- __.-_-.Distance to nearest lot Number iof lines------------------------__.-__-_ ength of each line_____ f�__�_ -�___.Width of trench.___ ----�---_._-___-_.__-_ Type of filter materiai,�_�__ trench---- ------- of filter material_-__��_______.__Total length--_-_�f ---'-------------------- ` Seepage Pit: Distance to nearest we11_.� .It -__-Distance from fou ation__4 --------.Dista ce to nearest lot line--fie-----_ ------- Number;of pits______-_F.-------Lining matenal� -Size: Diameter-_. .��___Depth---_--� _f_---___` Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_---__.._____-_-___-..--____- ) ❑ Size: Diameter-------------------------:------------Depth----------------------------------------------=-----Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance'from nearest building----_-_---.---_----_-------_-_-__--_-_-_-. ❑ Distance to nearest lot line ` line�_-j-__-�__ _-__-__•__-._�_�'�_!_ l ---------- ----------------------------- ----- _ _ _ _ __ __ ___�-2emode ------------- Remodeling and repairing (describe•------ -------------------------•-----------------------------------------•-----------=------------------------;--------------------•----------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and"rules and regul fions of the San Joaquin Local Health District. a , (Signed)-------- F ------------------ Contractor) 9 Pio+ BY: ----------. -- .... {Title) �/ ( plan, showing size ot, location of system in relation to wells, buildings, etc., can be placed on revers e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED"BY------------ --------------- -- ----------------------------------------------------- DATE------ BUILDING PERMIT ISSUED: ------- -- -- -- --- ------------------------------------------------------------ D TE------ - % -- REVIEWED BY---------------- -- -- _ DATE----- --- �----- --------------------- ---------------------•------- --------------------------------- -- - -\-----n---------------------------------------------------- ------%---------------------------------------- Alterations -- %----------------------------••---------- Alterations and/or recommendations:-------------------- J------------------------------------------•---------- _------------------ ----------------------------- ----�-'.`��---------._yfr -----------------------------------Mo-_--_- •- ---------•-----------M------------------- ----------f� --•-- --------------------------- ••-- -------------------------...-------•--------------- I = ---------- N Y FINAL INSPECTION BY:--------- ---------------------=--------------- Date------ --------------- --- ------------------------------------------- I 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 , Revised 1•57 'F FCO. "