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APPLICATION FOR SANITATION PERMIT Permit No. __ - .......... (Complete in Duplicate) Date Issued .-- r Applica+ion 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. JOB ADDRESS AND LtOOCATION__-N_�_W_ ion lf___ - ' - '----- Owner's Name ------------------ -_ I-----•------------------------------------------- ------- ---- -------------------------------- F : _ one ... .... ... v Ph -----------------+�--�Lb.. ":L_..0 !k'_ NilLIIAA --•---•-----... • ----- ------------------- Address �` --- Phone l ---- - k a Contractor's Name_____ _ Installation will serve: , Residence [Apartment House ❑ Commercial ❑ Trail Court ❑ Motel ❑ Other ❑ Number rf living units:-_______ umber of bedrooms _ __ Number of baths ^'YLot size _"_"j Q__r{__�l ----------------- . ; j _ � Water Supply: Public'system Community systemPrivate ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-❑ Sandy Loam ❑ CFV Lo _Clay ❑ Adobe ❑ Hardpan ❑ Pious Application Madg: Yes ❑• fNo ❑ _ New Construction-. Yes ❑ No Ll FHA/VA: Yes`❑ No ❑ 4 TYPE OF INST ALLATI(A TMAND SPECIFICATIONS��• (No septic tank or.�cesspool permitted if public sewer is available within 200 #ee+.). " Septic Tank: s Distance from neari T well___1�"7Distance from foundation_-_ Material = f i .. . .. 'r � — Size_"-J_ -ir L3l�c: Liqui cJepfh" ---�-� -Ca a ity _ "y' No. of cornpartments__-_- ❑ R 1 Disposal Field: Distance from nearest well_ _ -__.. Distance lro pp� p r foun F on____-`r�----Distance to nearest' I line-J-7' c from * _ .Width of trench_.Pte_ ❑• Number of�nes_____-_ _ _ Length of each line J-1- ; 6� To+al length-.---, � Type of filter material-�k��___Depth of filter mater�al__.,��-^_"_____-" , ,.� •" "'- _ i""_�Distanc rom�.fo�l dation__ l_ ._-__._.stance to nearest lot �SQepage Pit: -Distance to neares� well �a f Q fl Number of pits--- ---- ------Lining material- "-- -- _- -------Sizes �'a'► sr__________ ____-----Depth__ _©_�---------------- Ip p e from oundation----------- `"1`iF1i -gn.at�erial --"---- s #._..... Cess ool: Distance from nearest well________________"Distant Size: Diameter �-- -----------kDe th--------------------- ------- --------------- Liquid Capacity - 9a€s. , �,: L --`' Primo Distance from nearest well___"_ ------------------------------Distance from nearest building r ------------------------==-" --------- -------•------------ --------------- ^❑ v .. Distance to nearest lot line_~--- ----- -- -------------�-:----"'------ i I � '* Remodeling and/or repairing (describe :____ rn-.-"-- ----- - - {, ' ------------------------------------------------------ - -----__!TSP 1_1.. _ __________ ________ _________________________________________________ ____________________________ ________________________________________________________-__________ ____.- ____________________________ I hereby certify that I have prepared this applicatiomand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg tioris of the San Joaquin cal Health District. Sined - v = ---- _ "1 f 0... --------------------------------------------------`{ or Contractor) "p� By:----------------- --------- - ( 9 - = on of s stem in lation +o w Lritle) (Plot plan, showing size of lot, locafi y� ells; buildings, e+ ., can be placed on reverse side}. ":I. .✓tr FOR DEPARTME(4TUSE ONLY —. ---------i------- ---------------- DATE " - _ - APPLICATION ACCEPTED BY__ --} REVI€WED BY--------------------- --------i`_J-------------------•--------------------------'------------------------------ DATE----" BUILDING PERMIT ISSUED--- ---- - - - ------ DATE-------K- -------------------------------------------------- lte gtions. and/or, recomme a Lns - - *�',� . • •--- ------------------ -------- ----------------------- ----------•--------------- -------------------------------------------------------- ------------- -------------------- ----------- ' -" I / - I ----------------- FINAL INSPECTION, BY:..---'_` _..'- -- ----------- = SAN JOAQUIN LOC�AVHEA TH D#ISTRIC.T� 136 South American Street 300 West Oak Street y 132 Sycamore Sfraev-. 814 North "C" Street Stockton, California LodicCaliforniaManteca, California Tracy. California ES-9-2M Revisea 1.57 F.P.Co.