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APPLICATION FOR SANITATION PERMIT Permit No. .__ .` ?' (Complete in Duplicate) Date Issued .f 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 incompliance with County Ordinari`ce No. 549. ,y Q I .. �9 JOB ADDRESS AND LOCATION----- � ; _FSS: .M_CL----- ---------------------------------•-•- --•- Owner's Name--------T-Ramas-----------Y--- ------------ --- - Phone------------------------------------ Address---------- -------------------------------•---Address---------- ------------------------02.62-9-------- J� - �- h -- ------------ ---- Contractor's Name------------------------------4C4^ -. -----------. Phone----------------------------------- V Installation will serve: Residence [Apartment House ❑I Commercial ❑ Trailer Court E] Motel L] Other E]Number of living units: j---- Number of bedrooms __ ____ Number of baths _-l-___ Lot size ------ Z9, 57 l Water Supply: Public system Val"Community system ❑ Private ❑ Depth to Water Table s.3 _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No W? TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200�feet.) Septic Tank: Distance from nearest well-� _Dish ante from foundation_-)$-----.___ .. �' Materia'__ _ ��(1e/_QQ. --- No. of compartments__-----�.------- _Size_3 X -X-A-----____Liquid de th______ t--___-__.-Capacity---- a aci A�___ �d � Disposal Field: Distance from nearest well-_A[Q�I�__.Distance from foundation---15----------Distance'fo nearest lot line----�_____.- Number of lines_____-_:-1�.-------_--__-____Le� th of each line_______ Q Width cf°trench.___2 ___j___________�__e._ �-" - g � ---------„------ Type of filter mate ria kS_,--_}�QCK---Depth of filter material--"---1.g-- ______Total length-------" ---------19e--__._ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------.-------Distance to nearest lot fine________________ ❑ Number of pits----------------------Lining material----- -----------------Size: Diameter-----------------------Depth----------------------------- -- I Cesspool: Distancelfrom nearest well-----------------Distance-ifromff undation___._._____--._---- Lining material-._.____..___.__-_____.___________. O ❑ Size: Diameter------ ------ -----------Depth----------------------------1-----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------'-----1------------------'" `Distance from nearest building------------------------------------------ El Distance'to nearest lot line-------------------Ir ------ Remodeling and/or repairing (describe)-------------------------------- --- - ------' ------------------------------------------- i �M �` �` ------------------- -------------------------------------------:----� ----------• I II --s4 U0 I t� -----------------lM------...---------------------------------------------------"�`�` ----- ---------------- --- - ---------------------------- ----------------- ---- --------- ---- -------- I hereby certify that 1 have prepared'this application and that +he work will be done in accordance with San Joaquin County ordinances, Stale laws, and rules and regulations of +he'San Joaquin Local Health District, 'i (Signed)-•-------------------------------------------------- --- - -___Owner and/or Contractor) - By:_•---------•-•-------------#----------------------------------------------------------- ---------------------------------------(Title) (Plot plan, showing size of lot, location of system in relation.K.to wells, buildings, a+c., can be placed on reverse side). # FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY-------7.R_:0--- ------------ I�--------------------------------------------------- DATE--------- -Z ----�f---------------------- REVIEWEDBY------------- ---------'---------------------------------------------- ---IM------ -----------------------------------------. DATE-------------------•--------------------------------------- BUILDING PERMIT ISSUED."."-"- x------------------- --1 -- DATE-----------------------J-------------------------------- 1M Alterations an Vc� (ions----------------3------._ --------------� -----------� ------r -- ---•---- ---------------------------------- ------------------•----•-------•--------------------•-------------------------------- -----•---- --------- --------------------------------------------------------------------------- uN '!�nts -f-- ---• ---------------------- �M ----------- ------------------------------------------------------------------------------------------------ -------- r`l Nk � ---�-- -------------- `---- ---'1 ------------------------------------------------------------------------------------------------------------------- ------------- ------------------- / 1I T ------------------------------------------------------------ FINAL INSPECTIOp1sBY:.--- '� ✓ --- -- --- -_-- - ._ Date------------- I 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 F-?.CO.