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T 1 / f �' APPLICATION FOR SANITATION PERMIT Permit No t, Ar� � (Comple+e in Duplicate) 3�k ', 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 applicafiori is made in compliance with County Ordin ce No. 549. JOB ADDRESS,AND LOCATION------------ ----` '--- ---- --------- Owner's Name �---- d'� - -� ----------------------------------- Phone_; _Z41-l" Address -----------------•--------•------•------------•------------------------ -•------------------------ Contractor's Name_--------------------- ?_�°�'a --------------------------------------------------------------------------------- Phone_--------------------------------- Installation will serve: Residence 93 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number-of living units: _I______ Number of bedrooms :1___ Number baths ___1__ Lot size ___� a-___%_.-_�-7 ___--____________________ Water Supply: Public system ❑ - Community system ❑ Private Depth to Water Table �Sft• Character of soil to a depth,of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No E? ' Now Construction: Yes ❑ No [3"�"FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is.available within 200 feet.) Septicank: Distance from nearest well____ ___Distance from foundation---_.__5'--------Material_____-� -_-_t-=--________s____ _________ [+c� No. of compartments-------------' --------Size-1-1----'.-. ---Liquid depth---------�-------------Capacity----f-�' ........ - � • i Disposal F Id: Distance from nearest well_____-_Distance from foundation____ ______:.Distance to nearest lot line_=________ " Number cf lines---------------�------------___--Length of each line-----------70?___ _______- F Width of french--- Type of filter material __Depth of filter mater�al �_ ________-_Total length-___________ _______________________ 6� Seepage Pit: Distance to nearest well---------------------- from foundation___________________.Distance to nearest lot line--__----_________ ❑ Number of pits----------------------Lining material---------------_-------Size: Diameter----_------------------Depth----------------------------_---- a Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___________________________________-- F< ❑ Size: Diameter----------------------------�------Depth-----------------------•------ ---------------------Liquid Capacity----------------------------gals. ` Privy: Distance from nearest wef-------------------------------------------------- from nearest building-----------------------------------------. ❑ L}istance to nearest lot line------------------------------ ----------------------------------------------- --------------------------------------------------------- Remodeling and repairing (describe]:--,- ---. f- __ ----1rC l.oArl t---�f_et�r 8.11_.----- ----- �� -------- -----fir-------__�1�-- -� +i! ,z� _---•--<A-)----->_--A f-0-----�1..M -e-.€x.rs -- .% ----------- --------------�------------------------------ ----- -------------------------------------------- -------------------- -- - --- y .ef.#:1 - XML+ _ _1�e�- _ / ,_�t`t__i! !._ ti-+C E�•>v "ter'----------------- I hereby certify that 1,hav repared tho application and fhaiKlhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaq in Local Health District. (Signed)____________________ Owner and/or Contractor S •------ (Tit (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------- d- --------------------------------•-------- DATE-------------- -- A - _= -REVIEWED BY------------------------------------------- - = ---------------------- BUILDING PERMIT ISSUED------------------------ ---------------------------------------------------------- DATE---------T---- ---------- Alterations and/or recommendations---------(t-- ------------------------------_----___-------- "" !"' _ S t°`'' :.t JIy l �. t •!!4!.E?.t_®L .__L�_A .° 'Z� - tf' ' A ` 4'A t ° --------- ---- .. ~ • ., - � t t ------------------------------ r ---- -------- ------------------------------------------------------------ -------- -4-`?- --e--- --- �' ' G'n l� --- -------- 5 •t ri - ` L��tcN 4 G' q'(a bGAL TA�14 -�,L 77 CD t/� - Al T- T / FINAL INSPECTION BY:---- !`._ '�' ----••------------------ Date-------- _�-- f 1�fi ------- ' Ii SAN JOAQUIN LOCAL HEALTH DISTRICT 7-0 !1140 U S e� 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r E5--9-2M , Revised 1.57 F-P.CO.