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APPLICATION FOR SANITATION PERMIT Permit No.s�_G____�. (Complette in Duplicate) II Date Issued '!-- -'_S- Appli�a�ion is hereby made to the San Joaquin Local Health District for of permit to construct and install th work herein described. This application is made in compliance with County Ordinance No. 549. j 1 JOB ADDRESS ANPLOCATION_. - ---_-__ Owner's Name-- F 7 ••--------- ------ --------- --- ----- Ro---- Address----------•--`-. ---------------------------------------------- - - - -- --- hone _- Contractors Name------ - P ,�• = Installation will serve: 'Residence {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑/ Other ❑ jNumber of living units: --/--- Num1 ber of bedrooms _-o�- Number of baths --- -_ Lot size - _ --/._ -.•_______________ _ ,' Water'Supply: Public—system-❑ Community system Private'❑ Depth to Water Table Character of soil to a depth of 3 feet: lSand Gravel Sand Loam Clay Loam Clay'[] c P i ❑ ❑ Y ❑ Y ❑ Y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ " No ; New Construction: Yes No 2,-1 1 TYPE OF INSTALLATION AND SPECIFICATIONS: I(No septic tank or cesspool permitted if public sewWisava-il'a"61;ei�w�ithin20eet.) Septic¢ nk: Distance from nearest well-----------------Distance from foundation,------__---.------.Material---------- ❑ No! of compartments..--___.__--------- --.-.__-----._ Size---------------•----------------Liquid depth-------- ---Ca acit Disposal Field: Distance from nearest well----.- ...Distance from foundation--------------------Distance to nearest lot line---------------- NAber of lines------' -----------------------Length of each line-- --------------------------.Width of trench---------- ------------------------- Type -------- ` i Yp -------Depth of filter material-----_--- _---+_ -Total length---------------•-•------__--- T e of {filter material----- ,,-«,. .� ¢.� " ,. ��. - - �� 1- •- _ -., � ., ._ ----D•-f-- Seepage Pit: Dis�ance"to nearest weft_"---------------------Distant f m foun ation_-_-, Q..-.._..Distan�e #o nearest lotgline-��----_--._ tW ( Number of pits-------/------------Lining material- Size: Diameter----- -.___---.Depth-_---�j+ �}1 ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------- Size: Diameter Depth------------------------- ------------------------------ Liquid Capaci.tY----------------------- -----gals. Privy: -Distance-from nearest well-------------- `-.___- ----f.-Distance from. .nea. rest building ----i- -------------_--- -------------i= --------❑ " Distance'#o'riearest'lot line--------------- --------- - - ----------------------------------------------- - ------------------ RemodI eling and/or repairing (describe):--------- ----•--------•----------------------------•--------•-----------•--------• - -------------------------------------------------------------- -- = # t * i i� ------------------------------------- --------------•-------------------------------- ---------=------------------------------------••----------•------------- ----------•----•------------•-------------------------------- 1 hereby certify thatI have prepared this application and that.the work will be done in accordance with San Joaquin County ordinances, State la nd rules and regulations of the San Joaquin Local Health District. (Signed)_-_- - ------ -'------------------------------------------- 3 , ' --------- r tract gY� ----•--------- - ------- -•--- =---•----- = {Title) --- and/or on or] ------- - ----------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). E II t FOR DEPARTMENT USE ONLY APPLICATION ACCEhE-D�$Y-- 1 - -----=----- ----------------------- ---------- ------------------------ = E — DAT --------------------------------------- REVIEWED. BY =------ .-------% -------------------------------------------------------------------------------- DATE---- a - - - ------- BUILDING PERMIT ISSUED-----------=----------------------------------- -'------------------------------`•--------------.----- DATE-------- i Alterations and/or recoanlnendations:-------- --------- �.. F - l ------ - ----- -- --------------•------------ --------r •---------------------- ---------------------- ------------ `---------------------- '----- --------------------------- _ i j FINAL "lNSPECTIONl3Y:= "- L/ ,� ---- t" Date= "—�✓�� r-� ` • SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Y ' Stockton, California Lodi, California Man+eca, California Tracy, California ES-9-2M ; Revised W-2100