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1 APPLICATION FOR SANITATION PERMIT Permit No. A7\\ (Complete in Duplicate) 7 s Date Issued --------------------- A _:_/L Application is hereby made to the San Joaquin Local Health ,istrict for a permit to construe+ and install the work h described. V This application is made in compliance with unty Ordin e No. 549. m ADDRESS AND L CATION__ e------------ to/ ------------ ----------- JOB -----------•-•-------------�----------------•------ --- ------•------------ Owner's Name------ r•-------- ----------------------------------------- Phone----•------•-------- -•-------- - - - -- Address �•/ ------ == = ----------------------•------------ ------------------ ------------ n Lii Contractor's Name ------- A- i � ---------------- •-----------_- Phone.. - .270,16_. Installation will serve: Residence [[impartment House ❑,�,,,, C/oommercial ❑ Trail/er Court ❑ Motel ❑❑ Other ❑ Number of living units: _ ___ tuber of bedrooms _"_�Number of baths __f_"" Lot size "___/AG ""_"_"""._ Water Supply: Public system W Community system ❑ Private ❑ Depth to Wafer Table -S-0t. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�arclpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or•cesspool permitted if public sewer is available within 200 feet.) I ,` Septi T -k: Distance from nearest well__H(k�Distance from foundation Q- Material_....�`�---�-- --_..... P �� ti lti ------Liquid depth__J_5f""- Capacity No. of compartments___'r�____________.__Size_ +?_______.. _ 7'- � �f r s r- Disposa Field: Distance from neare t we _ ._.Distance from foundation--/#_.--.-.-.Distance to nearest lot line_________________ Number of lines_____--I--___-__ __ _ Length of each line____.5�_�'----------Width of trench"""�._t��______"""_"_"""" Type of filter material.... ._ • __: _De Depth of filter material -_.Total length___ f f. p Seepag it: Distance to nearest well__t`EroA.,1-------Distance m foundation"_ _________.Distance to nearest lot line__.____... ( �, Number of pits___________________"Lining material____ .�_�.`�.� __..__.Size: Dia meter--.3j- __.__..._._____... .� Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------:_.-_-_.______._____--.-._._._- ❑ Size: Diameter------r----------------- ------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well ________________________________---------------Distance from nearest building"""""""""_._________.___________..___.._. ❑ Distance to nearest lot line--------`---------------------------------- - ---------------•-------------------------------------------------------------------- ----- Remodeling and/or repairing (describe}:---------------------------------------------------------------------------------------------- i --------------"-------"---•----••------------------------------------------------=-----------------------------------------------------------------------•--------------- ----------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1--------------------------------- 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. DAY& NIGHT - ----------------------------� Con+rat+or)"' (Signed)------------ --------------$fftic"Yanfc 5ervire ]206 50. ----------- gY�----------• ----- ---------- -- ---------- -----------------(Title)---- -- ---- ---------------- -----------------------,---•-- (Piot plan, showing size of lot, Ioca�1&A1F#fRysq'e�fan relation to w Is, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- --- --------------- DATE------ -------- _ --- --------- ------------------•--------------------- - _-%-- ------ BY---------------------------------- - - --- --- - _ DATE------- ` BUILDING PERMIT ISSUED-------------------------- ---------------------------------------------- ---------- DATE------- -------------------------- Aiterations and/or recommendations---------------------------------------------------------------------------------------------------------•------ -------------------- ----------- ------- --------------- ------------------ ----- --- ----------------------------------------------------- ---•----------------------------- --------- .---4---------- ----------------- -� -`' ----- ------ '�-------- -ria'�o_Q1�--------- ----- --------------- - FINAL INSPECTION BY:--------- rSAN ----------------- ---------- Date------------`--- ---- --------- ---------------------------- OAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street p Stockton, California Lodi, California Manteca, California Tracy, Californi6 ES-9-2M . Revisea 1.57 F-P.CO.