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APPLICATION FOR SANITATION PERMIT Permit No. _} �. y (Complete in Duplicate) # - -� _ _ _ _ _Date Issued ��7 Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein descril;ed. This application is made in compliance with County Ordinanc No. 549. i JOB ADDRESS AND LOCATION-____- Q -- Owner's Name - - ---------------- ----...... - _ �r :� - �..r__. ---- - Address____..------ (� s � _. 3� .. - - Contractor's Name--------•------ r � -- -----------••-----•-•--- - - ----------- ---- .............'.... Fh f `/� Installation will serve: Residence P ��------------ one ........................•, - A artment, House ❑ _Commercial ❑ Trailer Court Number of Irvin units: - ❑ Motel ❑ Other ❑ 9` 1_-- Number of bedrooms �- "Number of baths -_ / Water Supply; Public. system �•-•= Lot sue _..,__x. Y - Community system �riv ate"❑ Depth to Water Table _:_--:`_ ft. - Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ` Previous Application Made: Yes No Y ❑ Adobe ardpan ❑ ❑ 4- New Construction: Yes 10 ❑ . FHA/VA:.Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or' cesspool permitted .if public sewer is available within' 200 feet. , / * • ! +-r- x -r Z• w1� Septic Tank: Distance from nearest weil..a�� - J - -- _._ .-_Distance from fou ndation' __.1-.•Material_____- �� No.,of compartme_nts---- .-..2- Size..._3 S_. l t �------------•--, �]'_ _ Liquid depth__.___�j.-- _ __ I 3 '+ r Capaci Disposal eld; Distance from nearest weif.!4•-Distance from foundafiio r Number of lines___-_.-�r-._- • - - "Distance to nearest lot 1i e 1 ___`Len th of each line_..._ �_.: 2! 9 � Typo of filter material,-.'--- ------- id of trenc . 2 Depth of filter material___..--/ - ---_---Total length_1_..J2,b Seepage Pit: 'Dist nce to Weare t well='=~�` Distance from foundation._,-- •*'.'-'Distance to nearest lot line_____.- ❑ lumber of pits - --- -= ---------- -----Lining material__...----- -..------ Size: Diameter .......... ..__ Depth--------- ------ Cess ----------------- Cesspool: � I ,_-_ A Distance .from nearest well_______________ # Distance from foundation.__. ------- -------- Lining material ---------- .. - --`- .. Liquid Capacity............................gals. Privy: Ck Distance from nearest well _________________--------- ________ __ _ f /'..l ❑ Disfance to -nearest lot line--: .... Distance from nearest building__ -_-•- W : – - 1 Remodeiing and/or repairing (describo):....................................... •---------•-......_.. ---_._....-- •- --- - ........................ , __ .-----------•--- = re •---- --- -------•-•---•---- y.j I hereby ate laws, at I have prepared this application end that the work will be done in accordance with San Joaquin County ordinances, State laws and uses And re ulatrons of the San Joaquin Local Health District. a f (Signed)-------•- ..................................... ..... .. _L(Owner and/or Contractor) By: ------------- •-•-------------=- - • ----- ---- -- - -------- . .. ........... Title)--• •----------------- -- ---- (Plot plan, showing size of lot, location of system in relation fo wells,' buildings, etc.,7can be place - -- d on rev - • e - -- -------------------------- rse side). - FOR DE�RTMENT USE.ONLY a APPLICATION ACCEPTED BY........ ..._ • _-• _ _- DATE E REVIEWED BY... ............. -- -----•--•-----•--------- •--- ....--••- --------------- ------------•.---•-•----.._ DATE BUILDING PERMIT ISSUED .............. I: --...-----------.._----------------.... Alterations and/or recommendations:_... ,_---_._...._..... •---_- DATE .......... ...... •_ -------•--- ••----• •-•--... - --•-•••.................•--•••..._..--•-••--•••-.......--------• : ► ..................... _..____-. _.. __..-__.__. .._ _. .._-_.__ _ ___ __ __________Y ...._...... F • FINAL INSPECTIONi-BY:-_ .... ................... .. ate .. --- •---� . •.,.� D. — SAN JOAQUIN LOCAL HEALTH DISTRICT 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 . Revised 1-57 VP.CO.