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4 a ; APPLICATION FOR -SANITATION -PERMIT Permit No.a y {Complefe in Duplicate) �/ � F Date Issued -_--1i d Application is hereby made to the San Joaquin Local Health District for a permit to construct and�sta I he or erein escri ed This applicafion is made in compliance ith County Ordinance No. 549. p JOB ADDRESS A LO TION__-•_- - A-/�,�-�� W-- - -------••------- ----------- ---- -------------- - i! ----- ---------------- -------Owner's Name------- - -- � --'---- V-- -- -------•------------------- ------ .f----=_•- __-- - _ Address__ _ _ _ _ ------ j�. -_ - one ------------------------------------ ------------------------ Contractor's Name ---------- + �� �'�•�- --------- - --- ---------- ------ Phone----•----------•--------•---- - Installation will serve: Resi ence [Apartment House ❑ Commercial ❑ Trailer Court Motet ❑ ther ❑ t °� Number of living units: -- _ ' Number of bedrooms _ -- _ Numbe°r of baths _ ----- Lot size ----- --- - ------------------ �. _ r / Wafer Supply: Public system R Y Community system ❑ Private ❑I Depth to Wafer Table -------- ft. { Character of soil to a depth of 3 feet: Sand 'Gravel ❑ 1Sandy,Lo;gNo ' Cla LoamI Clay Y ❑ y ❑ Adobe ®Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or` cesspool permitted f public sew his available within 200 feet,) U`( Septic nk: Distance from nearest weli___-:---? / x '___-____.__ istan¢e fr. found tion_1_Materi I_i--------------- - N No- of compartments________-- ,+-Siq-!nl+?� Liquid de th-_-_____- q P. `f----------- -- --- ---- Capacity__ 11 Dispos l field: Distance from nearest well Distance from foundation -1-0, to nearest lot Number of iiries '_______,' -- �`--- Len 'th'of.each line _ _ _ - - 9--------- _ Width of #ranch.r, T e of filter mater) - �"'f 4 �""''""` �1 YP " ' - - -- epth of fitter material-------` - �--_-`_---Total lengfih______________.,�-�/��-------__-- -- Seepage Pit: Distance to nearest well ____'._Distance from foundation ------------------- _Distance to nearest lot line __--______._____ - ❑ Number of pits---------------------- Lining material ----- ---- - ---___--..Size: Diameter--------_------ ------------------ Depth---- ----------- --------' - , 3 Cesspool; Distance from nearest well__________---___Disttance from foundation ___________________Linin material___.___.__ ___- --------------------- C ❑ Size: Diameter ------- ------------------------------Depth---------�.��,—'" -- ------Liquid Capacity ---------------------------gals. Privy: Distance from nearest well_______________________ ___------- _�---_---__p stance from nearest buildin iA- I ❑ Distance to nearest lot line 9 ��+ i --------- ---- ---- ----------------------------- Remodeling and/or repairing (describe)--------------------------- � I 0 ---------------- -h �_ -- ---------------- i-------------_------ _ I hereby certify that 1 have prepared this application and that the wor-------------------------------------------------------------- --------------------------------------------------- ----�� { --------------- ------•---- -- ---- -- ------------------------------------ p P Pp , will be done in accordance with San Joaquin County ordinances, State laws and ru s and regulations of the San Joaquin Local Health District. (Signed) ------ -- --------------------------------{Owner and/or Contractor) By:.-- -------• --------------------------- '------------------------------------------ ______ ==_-`--------------------- ------ (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- - � f ----------- DATE_ .__ --REVIEWED BY -- -- -------------------------------------------- -------------------------------- --------------------------------------- _ DATE -�--------------- BUILDING PERMIT ISSUED_.-----•---------- ------ ------------------------------------ DATE vL Alterai�ions and/or recommendations:------------------------------- - �� -5-----------------`-- _ _ _ _ _ - _ y /f - ---- - - --- - ---- ------------------ ------------- /17 FINAL INSPECTION BY., --- --------------------- Y:. ------------------------- Date----- .mac 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-P.CO.