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Permit No. APPLICATION FOR SANITATION PERMIT ry (Complete in Duplicate) Date Issued ------/ '""""" Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATIONJ Owner's Name------ j lop, :-7 Address---------------------- -a C. 1.4 -------- ------------ ---- -e__:�GI-K-e—e--------------------------- ------------ Phone---- ------- ---------- Contractor's Name--------------Oe Installation will serve: Residence Apartment House E] Commercial F] Trailer Court E] Motel F] Other E] Number of living units. 'Number of bedrooms -2-,--- Number of baths ___A___ Lot size --------- _______________________ Water Supply: Public system E] Community system 01-1:11rivate [-] Depth to Water Table 97- ff. Character of soil to a depth of 3 feet- Sand Ej Gravel [] Sandy Loam [j Clay Loam - Clay [] Adobe91'1H_aZrcd-pan F] Previous Application Made: Yes E]'i No 9,-_Ne, Construction: Yes El No [3-,' FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic TanDistance from nearest well________.__ ----Distance from foundation--------------------Material------------------------------------ No'. of compartments------ -- 1(----Size___________________________•__ Liquid dep�h--------------------------Capacity----------------------- DisposE I field: Distance from nearest well- Distance from foundation-- I -f- Distance to nearest lot line--$'-�*.Y_... )/�11 I r . V--------- ------ Number of lines----------I----------------------Length of each line--------6,./60-------------Width of trench----i P--Y --------- Type of filter ______-_Depth of filter maferial----tA............Total length----- Se Page Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ ine--,-------------- El Number of pits----------------------Lining material-----------------------Size: DiamEiter------------------------Depth-------------------- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______-____________-___- -------------- ❑ Size: Diameter---F------- --- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-___________..___-_________-______ ❑ Distance uilding------------------------------------------ Distance to near*est lot line C5 Remodeling and/or repairing (describe):______-_-_____-_____- "Ca'a-Zu';�_ J-------- ------------------------ --------------7-----------------------------------------------P---------------------------------------------------------------------------------------------------------- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ------------------------------------------------- -------------- I ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an and i- d-jules d-r-jgulafions�of /11 e San Joaquin Local Health District. (Signed)------------------------- _4�t------ ---------------- ----------------------------------------------------------------(Owner and/or Contractor) Sy:----------•-------------------------- ---- -----------(Title)_ ��c., can be placed on reverse side). system relation to m in (Plot plan, showing size of ovation wells, bui Sin , e Vt FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ---- DATE--------------- REVIEWED BY-------------------------------------------------------------- _t�------------------------------------------------ E_ 3-e-3--- --------- DAT --------------- BUILDING PERMIT ISSUED-----.------------------------------------------------------------------------------------------------- DATE---------- Alterations and/or recommendations:---------------- -- ------------------------------------------------------------------------------------------------------------------------ ----------- ------------------- 4----- --- ---- ______---.v_______-_-_-____------------I-------------------------------------------------- -------------------------------------- ------------- tr* _- ------------_ 7-------------------------- ------------------------------------------------------------I--------------------------------------------------------------------------- ------------------------------------------------------- -- -------------------- ---- --- --- ----------------------------------------------------------------------------------------------------------------------- ---------------------------Z!--------------- -- --------------------------- -- -- - -------I ----------------------------------------------------------------------------------------------------------------- FINAL,INSPECTIO -=---------------- Date----- 77---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 11' Lodi.-California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.00.