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1 � APPLICATION FOR SANITATION PERMIT Permit No. .G_3 (Complete in Duplicate) ) - - Date Issued 1 �_- •. 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 Ordinance No. 549. . i JOB ADDRESS AND LOCATIONf_____ zh) x Owner's N-a--m---e---------------- ------------------ -------------------- -------•--------_�-�' .r ---- �a-.•----�'!-- -C� - -------- -�----_--_4 � --. �---------- : Address � � -_ Phone _ Contractor's Name"'- ------ ---•---- ----------------•------------•-----•--�---/--------------- _-R_ Installation will serve: t Residence Apartment House ❑ Commercial ❑-`Trailer Court ❑ Motel ❑ Other Number of living units: __ _-- tuber of bedrooms _-_ Number of baths_" - Lot size ___- -'�_ --' iD-C9_ __ _ ----- Water Supply: Public system Community system ❑ "Private.❑ Depth to Water Table ____:._- ft. �. Character of soil to a depth of 3 feet: S d " ❑ Gravel ❑ Sandy Loam ❑ C�Iay'Loam 0 Clay ❑ Adobe Hardpan ❑ Previous Application Mede: Yes ❑. No�(New Construction: Yes ❑ No+E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or'cesspool permitted if'public sewer is available within 200 feet.) kltic t nearest + well_________________Distance fromffoundafion--------------------.Materia! __" No. of compartmenis-------' �` ----` 1 .� - q •d depth------------------------ -Capacity----------------------- _p ------------ -------- f". Ysposal eld: Distance from'ne'arest well_____ __ _�__D stance from•foundation--------------------Distance to nearest lot line ----- "-�_, l Number of lines-------�---- ----- ' :--,--Length.fof each line------s�D_-------------Width of french__---�-V--• Type of filter material ,- 4f [Depth�of filter material-__._--/ �:___-Total length___•o-----__------------ - w Seepage Pit: Distance to nearest well _____ ______Distance from foundation--------------------Distance to nearest lot line__,-__-_______.. 9• - ❑ Number of pits-------------- ------Lining material-----------------------Size: Diameter__.---------------_--- Depth --------------------- Cesspool: Distance from nearest well--------.-----/Distance from foundation_________________ Lining material------- ❑ Size: Diameter- - ___Depth t ---- -----------------------------------Liquid Capacity-------- ----- --gals. . Privy: Distance from nearest well--------- --------------_____________ _�"--- -Distance from nearest 6uildin ❑ Distance to nearest lot line -� -------- ------- g -- ( ,�a F ---------------------------- ---f Remodeling and/or repairing (describe):---------- ---_-----A----- �f4-cif ' -------------------------- •-------- --------motif f _ --- -------------------- ---- ------ / ---------- ---- -�r .E ' tel ' ! _ `----------------''-------- --------------- r. ------------------:------ ------------- ------------- ---------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State. lags,.and rules and regulations of the San Joaquin Local Health District. h DAY/ NIGHT (Signed) - �---------Upt, _.Tcm t__SQtV10R--- ------ -------._-- �Y=---•-----' � € HO 2-76.4--- - ------------------------------------- . n Contractor) ----------•--- xkbir;Ctr�if------------------------- w �.�-. Title-------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to`vrelfs, buildings, etc., can be placed on reverse side). 1 FOR DEPAIRtMENT USE ONLY APPLICATION ACCEPTED BY------------- ---- ---- -- --- -- DATE_.---- - --�` ' 1 - - REVIEWED BY --- ] --- -------------- 1" ' - - -------------- ---- ---------------- DATE . BUILDING PERMIT ISSUED___...---- 4' - = -- - -- --- - - ------- - ---- - --- I-------------------------------------- DATE Alterations and/or rec0m ndat' :• Ota _ -- _ ' --- ----- ------- --- ---- ---------------------------------------- ------ ------------- FI-P-54- ..... k --------------------------------------------------------------- ----------------------------------------------- --------------------------------W__--------------------- --------------------------------------------------I------------------------------------------- ------------------------ ----------------------------------------- ----------------------------------------- ----------------------i --------- ---------------------- _ --------------------------------------- - --- - - "----------•---••-- FINAL INSPECTION- BY:.. --- = _ - ------•------- Date-- ---- - ---- -- _S_ AN JOPZIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+ree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revises 1.57 f.P.Co-