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f+ APPLICATION i FOR SANITATION PERMIT Permit No. .. ..:S d (Complete in Duplicate) Date Issued ___-�.,�� j Application is hereby made to the San'JoaquinyLocal Health Dis#rict for a permit to construct a d iinnssf- th•�work herein described. This application is made incompliance with Caunty Ordinance No. 549. -- J ... �r. JOB 'ADDRESS AND OC TIO � � - -----------;_�� ;�7 Name � �. ___________ _ _ --•--------------------- ---------------=------------- A ress_- - � � � ._.- _ *• f ----"-----------------------------••------------�--_--Q----�•--- Contractor's Name_ _ -------`-----•------------------------------------------ Phone- ----- •---- - Installation will serve: Residence [rApartment House ❑ Commercial / ❑ Trailer. Court ❑ Motel Number of living units: -_f---_ Number of bedrooms. .- Number of baths --� ❑ Other ❑ -. ' i ---. Lot size __ __ _ • Water Supply: Public system y y ❑ Private'�]epth to Water Table _____ ft.Z.5' � -`- F ---- .---- Y ❑ Community system - - Character of soil to a depth of 3 feet: Sand I� '"' �, "i rrGravel ❑ Sandy Loam ❑ Cla ❑ y ❑ Adobe ❑ Hardpan ❑ c,,. .+a q y Loam Cla Previous Application Made: Yes No ❑ �New Construction, Yes R3"*`No ❑ - FHA/VA: Yes �No TYPE OF INSTALLATION ANDSPECII=ICATlONS: f ! . ��,[, if T ❑ t {No septic tank or`cesspoo! permitted if public sewer is available'w.ithin 200 feet.) Septic Tank; Distance from nI.earest weil-_`Q G1---Distance from foundation-- ' �/ - ... No."of eom artme ts_--- '""e"" "` '-` �r ��---- -.Mater al_-�--:C----/d -�- �- r p ----- --------Size_SL` i�3G:--��Ligwd dept --- --------- Capacity gd0_ Disposal Distance fro�mField: nearest weltfQa-- E D stance from foundation-- k to nearest lot Iine/D�"�-` LST Number oflines _ -"� �.-__--__ _ i Len th of, each line____ " g ----- _____.W,dfh of trench___::;I Type of filter°material- i_h�4 ____Dep}h,of:filter material___ __ - --- ? ,r � -----Total length-- res Seepage P. TDistanceAfo nearest wells= S_`--- -:Distance-fror1Vfoundetion___ -. ` • ._...Distanje�to nearestt lot line__l- - . Number�af pits- ---- y p ' S` .--- � -----_---Lining material___�j-Ci'.�__'_�' Size: Diameter----��-�--------De tn_-------------- Cesspool: Distancewi'om nearest well__:__,_____- Distance from foundation____________________Lining material_..________--____----___- -� ❑ Size: Dia�m�eter -- --- = - Depth_-------_--- -----------------------------------"' - Liqu id Capacity gals, Privy: Distance_to nearest-lot,lIne-__________:____6 Y Distance from nearest well__--_------."_-" --------------_--1___Distance from nearest buiidin j ----------;----------------- Remodeling and/or repairing (describe)_________ ____--Ilk _ -___ [ I. ----••--•------------- t t3 --------------------------------------------------- ------------------- r ------------------------------------ P. .... ! hereby certify that have prepared'this application and that the work will be done in accordance with San Joaquin-Count ordinances ate laws, and rules and regulations of the n Joaquin Local Health District. y (Signed)_. � - ------ --- Ow By:-----------•------=--•----•----- - J lri1 ner an r Co ct ---------------(Title)- o n ra of ' - - (Plot plan, showing size of lot, location'of system in relati to wells, buildings; etc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- REVIEWED ------- ------------------------------------'----------------------------- -------------------------- o REVIEWED BY-------•----' -------------- DATE_:---------------"-------------------------------------._ -------------------- --------- - ------------------------------ DATE fib'-------- UILDING PERMIT ISSUED - DATE ------------•--------•------- AI eratio and/or recommendations:-- r {tet ------- --------------- -. % -�- -------- -_ ---- - -r c-a•cr�----•----------------•-•-- ------- -------------------- U �. __._____-----._.T.' _ FINAL INSPECTION-BY:--- —_ ---- ---------- -------------- Date=--- k lc�;dg - - -- -- -----------,------ - " - �, SAN JOAQUIN LOCAL HEALTH DISTRICT Stockton, California 130 South American street 30D Wes} Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California LS-9-2M , Revises 1.57 F.P,CO.