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_J��'�'g�',' APPLICATION FOR SANITATION PERMIT ° IPeif ------------- (Complete in Duplicate) Date Issued Applica#ion is hereby made to the San Joaquin Local Health District for a permit to dnsrtFu�t and install the work herein described. This application is made incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------------- / - ----------------------- --•- -- � - - ---- ------ - Owner's Name `'• - " ---------- Phone__VAPA _...... Address l--- @ --------` h ��-�4- Contractor's Name------------------------------- � `d� ► ----- Phone---$-= Installation will serve: Residence jgApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms ._'Y Number of baths __/-_- Lot size "-�4-/Q - -----------------____-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table!_/v- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 11 Hardpan ❑ Previous Application Made: Yes E❑ No D( New Construction: Yes ❑ No ❑ n TYPE OF INSTALLATION'`AND SPECIFICATIONS: •11i` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Not n p e from nearest well__ --Distance from fou�n anon_____'__------Material___of ��,�---._ --_--, compartments--2-------------------Size�fs"A ul *• . '� ------Liquid depth__J_A---------------Capacity--r -g�+).� Disposal Field: Distance from nearest well__W ._Distance from foundation �p.__--.Distance to nearest lot line__9!�____. Number of lines-------�__.-- a _-----Length of each line----2.0--t---------------Width of trench_-�?.�{�'-__•-------_---_-- Type of filter matenal �-_Depth of filter material___1....._.___.Total length-----�r+�"�_"____ I Seepage Pit: Distance to nearest well______________-------Dist fronition__'_'W-.'..._..Distance to nearest lot line--_6_r___. Number of pits _ g ° ---Size: Diameter--- - � ____.Depth_.r7-0'------------------ p I----___-----Linin mat nal--_____- Cesspool: Distance from nearest well________________Dis nce from_fodation_---_--._-_..__-_..Lining material----_-_---_.__.--_-_____. .___._._: ❑ Size. Diameter--------------------------------------Depth------------------- ------ -Li 7-Liquid Capacity q ---------------------------ga s. I Privy: Distance from nearest well-__---:------------------------------------------Distance from nearest building ❑ Distance to nearest lot line ----------------------------•-:--------- g p ii t ------------------- Remodeling and/or re a�nng (describe ---------------------• ; ------- -------- i ! hereby certify that l -----------------••--------------------------------------- y y have .repared this application and that the work will be done in accordance with San Joaquin County. ordinances, State laws, and`rules and regulations ofefhe San Joaquin Local Health District. (Signed)_- - ------A -----=------------------------------------------------- -- -"--- Contractor) i -:--- -MAT "ilc ---------- ------------------------------------------------------ITitle)__ � -='� - - # (Plot plan, shoo. mg size of lot, iota+ion osystem in relation to wells, buildings, etc., can be placed on reverse side). I 1 1 FOR DEPARTMENT USE ONLY { APPLICATION CC---E--PT-ED- -_SY - -------- h --- - - DATE_ REVIEWED BY------=- � --------------------------------------------------- BUILDINGPERM T ISSUED-1------- -- ------------ ---------------------------------- - -------- ------- - DATE-- I*` --------------------___-_._ --------------- --- DATE-------, dations:----------- ---Alterations and/or recommen _ �- ----------- ----------- ---- _ - - ------ A --- - - - z – – ° ------ --- ---- --- ' SPG.- --- - - � - ---------------------------------------------------------------------------------------- .�"l�Y� � Imo--- ---- ----- -------- ---- --------- -------- - ----------- ----------- ------------- --------- ----------- ------- ------- ------------------ --------------- - - ------------------- FINAL INSPECTION BY:. it -- - - - --------------- gate r .-- ----- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S}reet'i! 300 Wes} Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California ` Lodi, California Manteca, California Tracy, California II ES-9-2M 8-51 Revised W-2100 ti