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t yo �r APPLICATION FOR SANITATION PERMIT Permit No. ----- ------__3___.. (Complete in Duplicate) v _ Date Issued 5---- , Application is hereby made to the San Joaquin Local Health District for a permit to cons4uct and install the work herein described. This application is made in compliance.with County Ordinance No. 549. r.,. .1- - !: Cd 4i41YO t un.J JOB ADDRESS ANI)i LOCATTION2----____ ----------- ------.____ __Owner's Name____ .--------- --- - __ --•----------- --------------------------------------------------------------. y Phone------• ------------ - J Address-------- - -------- ----------------- . `-6-----------------------------------------------•----•=-••------------------------- •' Contractor's Name - --- ---- --------------------------------------------------------- --- Phone..--- •-------------------------- N Installation will serve: Residen e ❑, Apartment.House,❑. Commercials. Trailer Court ❑ Motel El Other ❑ 1 I �. Number of living units: _ ._ Number of bedroom s -______ Number of baths -.------ Lot size -� +-.--------------- U 'i r. Water Supply:a!Public system'[:1� Commun'ity'system'❑ Private ❑" Depth to'Water Table _!7!7'-ft;— 4 , Character of sil +o a dap+li of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ , Clay'Loam ❑" Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes C] .IVo ❑ FHA/VA: Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i! Se tic Tank: Distance from nearest well__�_ Q_' Distance from fpundtion__.:! 1__ Material-_-- - =---- -- .;.. _ , "No–of compartments---------F;Z--------- Size_ , - i _ _,� Liquid depth---.s-----------------=-Capacity__:_3_0^. Disposal Field: Distance from nearest ell.- _ 70-Distance-from foundation____ '__ ----.Distance to nearest lot li e--- �_---_.p Number of lines________ }Length of each iinell>�_�_�Sb'Stl�. %idth of trench'.__ ' F De th of filter material_____ ___ __________Total length__--_--- _-_-_-__-__-_-_------ Type of filter material,X.--7____._ p Seepage Pit: `Distance to nearest well_"777!7.-'-'_f' _ _ _____'_!'Distance-from-founddatio_n� -"-___::.Distance to nearest lot Number of its __ _____ _________Linin material___ ' ❑ p 9 -----------------Size Diameter - `----- -----Depth------------------------ --•-- Cesspool: Distance from nearest well-------------- I_Distance from foundation °_�------------Lining material--------_____________________------. ❑ Size: Diameter---------- -- .---- ": ,='-De th-_--`----------------------------------------------- _ __ :Liquid Capacity______________ — g ._ _ ;—.�•� ,..{ re+-..�.�#. 'r' 't-n�qw+�" 3 +IW".T.y.. r: , .r i.F. .y .�..�y. f Privy: Distance from nearest well " _.. i"'!'"" y.._Distance from'near1 est buildm ___ ______________________ _____al5.., ❑ Distance;to nearest lot line- ----_._.�.—.—----------------------------- 7, ----- F _ Remoking and/or repai ing (describe): ,- Jh -*t f-.�- -it( - t""�`� -------------------� --•-----------------'--- ----- t .-.._.---- ----------- ----------------------- --- - ------------------------------ ------------------------------------------•------------------------------------------------------- --------•----••---------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San,Joaquin County i ordinances, State laws, and rules�nd r1gulations of the San Joaquin Local Health District. [Signed) -- :` _--�- -- --:—-- --- --[;--- ---- --------------------------------,-------- - - �'._.(Owner and/or Contractor) By. (Title)-------------------------------- ------------------------------- (Plot ------------ - ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY w _ .r .. APPLICATION ACCEPTED BY-=-- ------------ --------- - -------••----- - ---- - = -----------= 'DATE------- REVIEWED BY. ------------------------------=-- ---- ----------------- DATE--------=--•-, -" ;�.�, BUILDING PERMIT ISSUED---------=---------------- ' ------------------ DATE------------- ,--------------- Alterat_ions and/or recommendations:--------------------------------------------- ------------------------•-------------- = --------------------- --------------- ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------.-___-_-----_....._-___--_-_._-_------.---_----__-. ✓' ` :eJe 9. FINAL INSPECTION--BY: -------------- ------ Date 4 , '-=---- -----`2 -------------------•---- 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-9-21x1 , Revised 1.57 F,P,CO.