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APPLICATION FOR SANITATION PERMIT Permit No. } (Complete in Duplicate) 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 application is made in compliance with County Orante No. 549. J08 ADDRESS AN LOCATION_I-_ 6� - - `wi - 8 Owner's Name----- ---- --=-- -------------------------------------------------------- __-- ----------------------------------------•------- - = •------•-------- - Address - ----- = one s l � , -- ---- - --- -------------- ------ -------------------------------------------- Contractor's Name___ ��_ �s ------------------ -----•------- ------ Phone__ ----- 3 -) Installation will serve: esidence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel t - -p_ «� ❑ Other ❑ Nut-fiber of,living units: j_____ Number of bedrooms ___I-Number ofwbaths ________,Lotsize -------- + Z__?t_)- `O Wafer Supply: Public system �Community system pp y' ,Y Y ❑ Private ❑ Depth to Water Table -___--_ ft. Character of soil to a depth of 3 feet: Sand. Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes I No ` ❑ New Construction: Ye"s ❑ No [✓]� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND. SPECIFICATIONS: (No septic tank or'cesspool-permitted if public sewer is available within 200 feet.) ept> ir, T nk:f s Distance from nearest well_________________Distance from foundation--------------------Material_ No. of compartments----------- --------- --Size --------------------------- -------------- -_--:-- ---:-__Li uid d th___--_--- -------- -_Capacity -- q 7i? ----------------i`----- Number of lines_________-_I___Il `Distance frorii-foundation_- (L__�_t_---Distance to nearest lotiline----�-------. P Dispos 1 Field: Distanee from nearest we ___ ________ 5 Length of each line _ . __ _ __' 4 Type of filter material__ --- = g `� Width of Q ,, --Depth of filter materjal___ :}- ------------Total length_______�---- S Seepa e Pit: Distance to nearest well- ____ ----Distance Ha3unclation-1-f0f____ -�fl -------- 'st rye to nearest lot li�_- --_--_Number of pits_ __________-Lining material_____l __,_Size: Dia mefier ; 1 - ------ Depth_-- --Z__ ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation ___.Lining material------------------------------------- El Size: Diameter----------------------- -------------Depth------ Liquid Capac;fY----------------------- ---- is I -------- � . . .�,-.,:.--.-:-------_ ------- gals... Privy: Distance from nearest well_.- ---___ -------------Distance from nearest building / ' 9 ❑ Distance -to nearest lot I+ne---------------- -- -------_ -._-- ` - ---------------- if Remodeling and/or repairing (describe)-------------------------------- ! ------------------------- ______ - ____--__________________--__________ ------------________----------_---------- a ____ __________________________ _ _ --------------------------------------------------------------__________________________________________________________________________________________________________________________ _ 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. Si ned C I { g } �— I ------(Owner a or Contractor) RY----------------------------•------------•------- Title -------------- ----------------------------------------------------------- (Plot plan, showing size of lot, location' of system in relafion to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______ __-__ ---_ --- --- ------ ---------------- ----------------- DATE -- REVIEWED BY--------------- -------- -----------4-- -�---- --• -- - - --- -�- ------•----------------------------------- BUILDING ------------- --- -- ------------------------------------ ----- DATE PERMIT ISSUED------------•-----'----•--------- -- - - --------•------- - ----- ------------------- - --- DATE - ----------------- 1 Alterations and/or recommendations:_ - ------- ----------- -------------------- ---------------------•---- --------------- --------------------- �. T ----------9_�--------c}�1< -------------- .C�- -— ---------------(fwq --------- ,--K---------x=T G------- � -------- ---------- O----`CAS -� ..--- ��----1�ocrt---- -�lv-�•�c�-----��,-- --•--------------------------------I - ------------.---•------- ------------------------------------------ - - -------- FINAL INSP TION BY: �- Date_ . --------- l IS 1�1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California814 North "C" Street { Lodi, California Manteca, California _. Tracy, California ES-9-2M Revises 1-57 F-P.CO.