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APPLICATION FOR SANITATION PERMIT Permit No. -__9F' _ .� ... (Complete in Duplicate) � .. �. ..._._M. a _ 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 kwith Cou #y Ordinance No. 549. JOB ADDRESS A LOC TION______ r _ ------ - I ---------------------------- -------------------------------- -- Name---- ✓fit dry "_w, - ----- -------- - -- --------------------------------------------------------- .� r.. �.._ ,u � -. --- Phone -�•--------E----------------•-• Address------------- ----------------------- '�' '- - ' - ?� _: E Contractor's Name__--- ,� / # .. /1 - .. it :. � a�r- .. .. . •.�� w --if_•.. �.� Installation will serve: Resid ce }partment House ❑ Commercial ❑ Trailer Court ❑ o el ❑ Ot er ❑ j r Number of living units: �____sNumber of bedrooms __Z_ Number of baths __ Lot size �lC --- --- ------•------- Water Supply: Public.systemIm/Community system ❑ Privafe'f❑ Depth to Water Table _f--_-__ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E]Q Sandy Loam ❑, Clay Loam E] Clay [I. Adobe Hardpan E]- Previous Application Made: Yes Ll Sand Consfruction:'Yes [ No ❑ FHA/VA: Yes ❑ No F i TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or°cesspool permitted i ublic sewer is available.within 200 feet.) i / Septic 'ank: Distance from nearest well-__ 1 _ -- - istance fro ou ajtion_______ Materi If_- >____:-.. ---- `--_-:----_- _ ff o�` . No. of co rt -----11J-- ±Size __ .___Liquid e th" '_-�� ff - } P. f "T--------- Capacity Disposal Field: Distance frorrm'nearest w IIA�Mstan from fcundatio,69!�'e+t / C� _ __.bistance to nearest lot linea________________ , Number of lines----------- __ _.__ -___-_-__-__Length,of each line___________-� _r�-----Width of trench- ____ 4j------------ Type -__• - Type of filter material 71. f;At gd fh of filter material_-__. ! % - --- s p - - - ----�---Total length---------------�-`----=-- �'-------F ------- See Pit: Distance to nearest w II__ ' - _Distance orri fo ndation__: pieta c7 to nearest Sot line__ ----------- Number of pits---------- - -------Lining material__�� ize: Diameter---.-_4 __-�_ -Depth---------- ______- I - Cesspool: Disfance from nearest well-----------------Disfa`rico from foundation----'_:''__--R-------Lining material__-__-_-______---__Ej F Size: Diameter------ ------------------------------Depth I -=-- - -----Liquid Capacity----------------------------gals, Privy: Distance from nearest well--------------------------'°-__-------------------Distance from nearest building-_-______--______.-______. ❑ Disfance-ta nearest lot line~__ __ ,1 I � ----------------------------- R mod ing nd/o raP r n scribe}: = f t - �� , --- ------ ----- -----------------------------•-------•--------------------------- --------------------------------- ------------•--------------------- ------------ :------------ ----------= = -------------------------------------------------------•-----•--------------------------- - --- I hereby-certify that-1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,--Stafe laws, and rules and regulations of the San Joaquin Local Health District. 11 e -(Signed) * -------.(Owner and/or Contractor) Plot Ian, showing size of lot, location of system ff - ------------------------I--------. -----------------------(Title)----------------- ------------------ -------------------- ( P 9 � � y min tolwells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY - - --------------------------------------- - -------------------------- --------•------------------------- DATE----' ------- REVIEWED BY------------'-------------- '1-.__ DATE ' - --- --- BUILDING PERMIT ISSUED----- N=---------------------------------------- DATE--- Alterations and/or recommendations__ .__ - ---.---=-- •------------ ----------------------------- ------ ------------- - -------------- _� = .a .G --- -L ._.. _.�c c. er. -cam ! . - ------•----••__- -- j. �x1 ! -----•-----------•--------- _ -•---------- ---- 5 =- ------------------- --------- ----------•---- --- -- - .� FINAL INSPECTION BY:--- ---- •- ---=---- -Date--------- 7 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 ='E5-9-2M Revisea 1.57 F.P.CO.