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i APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) Date Issued r i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein plesgri�ed. 1 This application is made in compliance with County Ordinance No. 549.' ,ts JOB ADDRESS AND LOCATION_- - 8X•• i 1 K-1-villa fl x Phone Owner's Name------------- C�.C --------- -------------- - - 0 Address............+ l-------- ` •� i ••--`-- . f r---------------------------------------------------------------------------------- -------- ---•�----------------- Contractor's Name____-- f�--- �4-/ -I _fs. `X-._ f_ R _-Y_II�G=------------------------------ Phone---k�fP Installation will serve: Residence Apartment House ElCommercial E] Trailer Court El Motel ❑ Other El Number of living units: __ _ -- umber of bedrooms ___1-_ Number of baths _/____ Lot size __` ____. _----1-- ---y------------ Water -----Water Supply: Public system 'it s stem ❑ Private ❑ Depth to Water Table.2V ft. Loam Clay Loam Clay Adobe ❑ Hardpan ❑ Character of soil to a depth Al"o3 feet: Sand Gravel ❑ Sandy ❑ y ❑ Y ❑ Previous Application Made- Yes ❑ No ❑ ew Construction: Yes No ❑ FHA/VA: Yes ❑ No E] TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) + ` ,...— r Septic Tank: Distance from nearest well_.��-._____Distance frr9m foundation-_10:_____- -Materi/i=____ .:-`=-------- No. of compartments.____ _ _Size Capacity - Li uid'de th__ + - Ca acct 06_-�� r f Dis os I Field: Distance from nearest well._.6_V__ __Distance from foundation----f-Q__ ____-Distance to;.nearest lot lin e �______ Number of lines-----_�-------------- ----- -- Length of each line_-----4��_�----�.�-_--.Width of trench_- -��-------------_--_-- Type of:filter material__ROG_�-___Depth of,filter material____IF---------Total length____V1�------------------------•--- Seepage Pit: Distance to nearest Well _____Distance from foundation--------------------Distance to nearest lot line---____________ ❑ Number of pits---------------- Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation-----------.--------Lining material_________________---________________- I ❑ Size: Diameter------------------------------------- Depth------------------------------ ---------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well.-.----------------------------------------------- from nearesf building______________________--_______--____. ❑ Distance to nearest lot line-- --------------------------------------------•------------- -•---------•------------------------------------------------------------------. Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------------------•-------------------------------------------------------- ---- -----=--------------------------- --------------------------------------------------------------------------------------- ------------------- --------------------- 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 9 ) -' jl 4-1 -p—,IS ._ _ lr �----� (Owner an��or Contractor) --- --- Title . ,�1Y1LZ .fC-------- -- By—___�-_ - -------------------•------ ��------ ---- ( � � i jPlot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be placed an reverse side)' " FOR DEPARTMENT USE ONLY 1 _ APPLICATION ACCEPTED BY----------- _ DATE-------- REVIEWED BY-------------------------------------------- -- ----- -- ` DATE RATE____ -. BUILDING PERMIT ISSUED Alterationsand/or recommendations------------------- - ------ ------------------ --------------------------------------------------------••-- ...... ------------------------------------------ -------- ----- -------------------------------------------------'------------------------------------------------------------------------------- -------------------------------------------------------- -- FINALINSPECTION BY �_ ------------------------ Date...!,_"P..... ....................... ----------------------------- 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 , Revisea 1.57 F.P.CO. r -