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! IIr APPLICATION FOR SANITATION PERMIT Permit No. I (Complete in Duplicate) /Q�� R • R' • - Date Issued .--. -----7__5_ ade to the:San Joaquin Local Health District for a permit to construct and install the k herein escribed. Application is hereby m This application is made in compliance with County Ordinance No. 549. ; JO ADORES AND LOCATION- �� + ' Owner's Name----� 4-j! f-!- .. ` .lJ'Yt' Fie d� E - -_ ..,- � Phone----•------------------------------ Address- -_- - t L - -- - --"----- •-_==-•_•-----•-•-------------------------------------------------- Contractor's Name- -------------------------------------- -•--- Phone lnsfallafic�n will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other leg Number of living units: ---------Number of bedrooms °- -- Number of baths n- Lot size -- �� .---- II Water Supplyc Public system El' "Community system ❑ Private VDepth to Water Table '� t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑_ Sandy LoamC lay Loam ElClay ❑ Adobe[I Hardpan'❑ Previous Application Mader Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes [J No E] TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Y r� Septic Tank: Distance from nearest well-- - --: --_Distance from foundation__J_t` ---_._--.Material----C ✓* 4 P ----2------------------ size_/2{_X -- ---•p- No� of tom artmenfs-- -- -----Liquid --- ---------- (!� " Disposal Field: Distance from near es well__W-------Distancefrom founda ion--A-* - * lance to nearest lot rline,-c)---:?" © —Number of lin es_-----�------------ - � j � Length of each line -�}-----------�idth of french-__,1A,�__ Type of filter material___,- PL-:Depth of filter material._-----� -___-----Total length---- ®_____________ Seepage'Pit: t Distance to nearest,well----__._- _---_Distance';f'om foundation-_----------------Distance to nearest'lot line'------------------- F R Number of pits-1-----=--------------Lining material--- "----------------Size: Diameter-------------------------Depth-------------------- ------------- r { y, , � 'Distance from foundation-------------------- material----------- Cesspool: Dis#ante from nearest well---------------- ❑ Diamete -_-__-._ _ ------------•r-------------------------- --- I Depth_ = Liquid Capacity-------- ---•--.gals. Priv ( r y:: Distance from nearest well----------------= ----- Distance from nearest building --------------------------- g El Distance to nearest lot line------------------------------------------------ -- ------------ --------- --- ---- Remodeling and/or repairing (desc ibe):---- - :`..o ------------------------------------------------------------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, and rules and regulations of the San Joaquin-Local Health District. (Signed)._ - - ------------------------------- ---------------------(Owner and/or Contractor) By. •--•--- -------- ----------------------------- ----------- ---------------------------------•---------------•-------------------(Tit --------------------------------------------------------------- - (Plot plah,showing size of lot, location of sys em'in relation=to wells, buildings; etc.;•can be:placed on-reverse side). FOS RTM T USE NLY APPLICATION ACCEPTED,BY2__ •- ____ -- ---s °- �- -------- - DATE---- 1, ;�� _ - ----•---- I REVIEWED BY-------------=---------------- ------ -----• DATE--------- ` ---------•-------------- ' BUILDING PERMIT iSSi.JED----------•------------------- ----------- ` ---- --------------- . DATE.--- ---------------- ------------------------------- A aerations and/or recommendations:-- _------_- - f� ------- --------------------------------------------•-------••-----•---------------------•----•-----...------------------------- /!' U --------- f ----------------------------------------------------------r-------------- _ -------------------------------------------------- FINAL INSPECTION-BY:- ':.+-�s ------ Date------- , ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton,'California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1•57 F.P.M