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APPLICATION FOR SANITATION PERMIT Permit No. _1_I-___!j-____ 1l� (Complete in Duplicate) V • Date Issued .__(f!-/_s7A_5.?S___. 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. JOB ADDRESS AND LOCATION__--__ f Owner's Name fC. __- ----- Phone. t Address �f `, •- - ----- -------------------- - ----------------------- /, f Contractor's Name------------------- -- -T-•-�:�£.�-r------n --Installation will serve: Residence Apartmen ❑ Commercial El Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms __ __ Number of baths 1_ot size _____________ Q- --•____ U T r --------------- Water Supply: Public system Community system ❑ Private ❑ Depth toiWater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe E] Hardpan [DPrevious Application Made: Yes E] No ❑ ` New Construction- Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well___ Q,L Distance from foundation___! -----Material______, j��C!- ----------_ ❑ No. of compartments-.--2Size_____ fr`� q p .� P Y--s`pQC �, ��L –Li uid de th Q Ca acct Disposal Field: Distance from nearest well___��WGDistance"-from foundation__�!0___------Disfance to nearest lot lin /-_jy-_..,. Number of lines------------------- ------------Length of each fine------- ----------------Width of french-----2--V-------------------- � Type of filter material_ i -----Depth of filter material--- le„n�gth_______ — Seee Pit: Distance to nearest !well_.__ Distance from foundation_-_. s a ��..-- ��___.___Distance�-b nearest lot line-- Number of pits ._:___/-------------Lining material__-___ /t� -Size: Diameter____•-, � -.Depth______a�4.--.___---__.._._-_ Cesspool: Distance from nearest well-----------------DistZ fo dation....... __=_______.Lining material____-__-.________.__.____-_________ G ❑ Size: Diameter_ Dep ------ Liquid Capacity gals. ) Privy: Distance from nearest-weil------------------------------------- ________Distance ,from nearest building____-_-_________________________________Distance to nearest lot ---- ---Remodeling and/or repairing (describe):------------ - S____•--•----- -- - -- t -------------------------------------------------------------------=------------- ------------------- - {�4- - --------_`. ------------------------------------- -------------------------------------------------------------------------------------- ------------ --------------------------------- ------ ------ I hereby certify that f have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rules and reg • ns of fhe San Joaquin Local Health District. (Signed)------------------------ --- ----at-------- --- ----=- _e (Owner and/or Contractor) BY: .,c_�p -------. ;� (Title) �� ------------ , �,c (Plot plan, showing size of lot, location of system in relafi to wells, buildings, efc.,+can be placed on reverse side). FOR DEPARTMENT USE ONLY '. APPLICATION ACCEPTED BY------------------ ------- DATE REVIEWEDBY---------------------------------------------- ---- ------------------ --------------------------------------------- DATE--- BUILDING PERMIT ISSUED----------------------- -- ----- ----------------------------------------------------- DATE---- - ------ •- -------•-------- - Alterations and/or recommendations:______---------------- ' t ---- 4 � - - --- - ----- � r =�... ` J ---------------------- --------- ------ --^4'� - - 7 � - n - q5__r -- --- --- ----- ------------- --------- G FINAL INSPECTION B - - --- - - ---- --------------- Date...... A-(�,/ --��----- -- - - ----------------------_---- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT �, s 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 , Revisea 1-57 F.P.CO.