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APPLICATION FOR SANITATION PERMIT Permit No: _____l.__G.. L (Complete in Duplicate) l/ �— .�. Date Issued ..---/-j.-�r-�•'---� A plication is hereby made to the e�Son�Joa uin Local Health District for ` pp y q permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, a JOB ADDRESS AND LOCATION_----- - --.-,5 A-4- - , / = `d - ua�- -----------�� f -------------------------- Owner's -- Own r' Ne s - - - Phone-- 4/` � Address-----'"�'�-�- �_:�i�i��------��---••-�. -�C-,=--- 7'&---------------------------------------------� } Contractor's Name ' - ---------------------------°--- F Phone.__ ^'. Installation will server Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel'❑ Other ❑ . g 3--_ Number of baths ._/_�-Lot size ______.___f�_�_r�3C_•/ -� Number of living units.-.j.--.-___._ Number of bedrooms _ _ -----_•_•___-_-.-_,_ Water Supply: Public system!.[:] Community system ❑' "Private Depth to Water Table .... ft. - Character of soil to &depth'of 3 feet:G Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam El Clay E❑ Adobe„ Hardpan [j Previous Application Made:" Yes E] -No � New Construction: Yes g_ No ElFHA/VA: Yes,4,,� No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: DiSTance from nearest wells ._.__Distance from foundation___�a___._._--,Material________ ___________________________ _ "r io 4 .- t`". ?. + adv Disposal Field: Dotance from of rnearest well_._-__ Size-----t--"5 <Liquid depth_..--- •-•-•---------Capacjfyt_ ___ p e _� :Distance from oundaon____ ____.._.Dis� to to neare�stot li ! - Number. of lines-------��------------------------Length of each line----_,_-- ---------•--•_-----.Width of trench-------�---_"-----------�_-- Type of filter materialDepth of filter material-.__-_ Af �r. -_._Total t length_____ -------7-7- Seepage Pit: Distance to ni arest well-----------------------Distance from foundation__-...................Distance to neaiest lot line_________________ ❑ - Number of pits----------------------Lining 'material------- ---.Size:'Diameter--------:--------------.Depth--------------------------------- Cesspool: Distance from nearest_well-----------------Distance from foundation--------------------Lining material,_______________________________.__. ❑ Size., Diameter------------------------ Depth------------------*=---------------!np f7_-_ Liquid Capacity----------------------------gals. ell (� i Privy: Distance from nearest w -_---°_; _ _ !Distance._____.__ _____________________ __._.._ from nearest building_____r___.____-----___________._______._. ❑ Distance to nearest lot line__- -_ ' --------------- t _ - • • IF Remodeling and repairing fdescribe)-----.---------------_------- -______ ;__-'_____________________________________ f __ _____________ ------------------------------------ y ---=-i-------------- t I ------------------------------------------- - — - - -------------•----•-------------------------- I hereby certifythat l have"prepared this application and that the works will be done in accordance with San Joaquin County ordinances, State laws, a`nd rules and regulations of the San Joaquih Local Health District.'] --------- ........ -------...... - .)(Owne�end/or Contractor( y ---------------------y-------------------• ----------------------------------------------- ----------------I-------------•--(Title --------------- ----------- (Plot_pla�showing size of lot, location of system in relation to weflk, buildings, etc., can be placed on reverse side}. r � t i FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY--------- ----- DATE REVIEWED BY------------ ----------------------------- SATE - ----------------------------------------------- ---------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------ -------------------------------------- Alterations and/or.recommend ations---------=-------------- ---------------•----•--------------;•----- -------•-•---------•---•--•----- =_.... -�- '�. _ -- - ' = �. :-------------------------------------------- ------------ FINAL INSPECTION BY:_--_"' �------------= = Date ----------------- ---------------- 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 . Pevisea 1-57 FRCO_