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APPLICATION FOR SANITATION PERMIT Permit No. 4 (Connplefe 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 in compliance with County ante Ord"" No 5 9. IVA CA14-- JOB ADDRESS A LOCATION__ -_ .�-------- 4 -- P, 0011�1 1 ; --------- ----- -- -- ------------- -- -- -- ----- ---------I---------------------------------------- Owner's Name---? ------ -- ------ - ----------- - - - - --- ------------------------------------------- ----.- Phone Address--------------- I., ---- ----------- ----------------- Contractor's Name------------------ -- ---------------- -- - -- ------ ii I�- ------- ----------- ---------------------------- Phon'Aft-------------------- Installation will serve: Residence Apartment House E] Commercial E] Traile - Court El Motel 0 Other ❑ Number of living units: _i/--- Number of bec4ns --cP-- Number of baths _/]Lot size -----45A X-/1410----------------------------- Water Supply. Public system kr-11Community system Elv',Private E] Depth to Wafer Tablevo_ ft. Character of soil to a depth of 3 feet. Sand E] Gravel ❑X,Sancly Loam Ej Clay Loam El Clay [:1 Adobe 9j-"'H'ardpan E] Previous Application Made: Yes E] No T_ ew Consfru&2Yes 0 No 2' FHA/VA: Yes Ej No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool p;rmiffed if public sewer is available within 200 feei.) I Distance from nearest well--j-------------Distance from foundation__-_._ ------------Material j 7 k -------------- ck no-of compartments----------- Size--------------------------------Liquid depth--------------------------Capacity------- f!#Dispos0�tiwj j Disfance�from nearest weIL-1----------- -Distance from foundation--------j------*------Distance to nearest lot line______________-. ❑ Number of ...... -----------Lengt h of each line-----------------1-----------Width of french Type of filter material---------- --------------Depth Depth of filter material-----------------------Total length------------------------------------------ 1 4 1 - Seepag Pit: Distance to nearest well__-__.--_____:___--_Distance' / Distance to nearest lot line____._____ ----------------Distance, 'M f - inclation-A----------- Number of pits-1. 2-S-1 ----------Lining material(- _3Zx___Size: Diameter---133----- Depth-Depth ---------- Cess ---------- Cesspool: Distance from nearest well-----------------Distance from founja_+�8`n------------------- Lining material-------------------------------- El Size: Diameter ------ —II I - --------------------------Depth----------------------- ------ --------------Liquid Capacify----------------------------gals. Privy: Distance from nearest. well__.. ---_______________________________________Distance from nearest building-____.___.______--________-------- F❑-1 est lot line Distance to rear" Remodelingand/or repairing (describe):--!------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- --I-------------------*----------------------------------------- - ---------------------------------- -------------------------------------------------- -----------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------I------------ ---------------------------------------------------------I -1--------------------------------------------------------------------------------- I hereby certify that I have prepared_ this application and that the work will 16e done in accordance with San Joaquin County ordinances, Sf wsano, r I1.,es a egu!afions-6f%ffie San Joaquin Local Health DisT'ricf. Y9 F_ ------------------------------------ , r#% f, I , I (Sign-d)---------iU--- --------------------------------------------- e ------------ Owner and/or Confracfor] -------------------- & "- -, - - -Ry:---------------- I+le) ---------------- ----------- to wells, buildings, e c.i, c%a',n"6e'kpIa`ce'd,on-reverse side). - --- --------------------------------- -----------------(T- ----- ------- (Plot plan, showing size of I ti ystern in re 0--plocaatlo_-n,6111f��Sz FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- T --- ---------------------- -------------------- ---- DATE---------------- -- REVIEWED ATE---------------- -REVIEWED BY-------- ---- --0,------------------- - DATE BUILDING PERMIT ISSUED------_-------- ---- - - DATE_ __ul------------------------------------------------------------------------------- - Alterations and/or recommendations- ---- - - A ----------- --------------------- . ........-�20------ ----- -r---------- --------- —----------I--- -------------------- --------------------- ------ ----------------- - - ce-4-A-CA-Cel-------- -------------- ---------------- 216�- FINAL INSPECTION BY----------------- ---------------------------------------------- Date--------------------- - ---------- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfr"f Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Rev;sea 1-57 F,P,CO.