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¢r APPLICATION FOR SANITATION PERMIT Permit :No. -- --.----. I � d1 J (Cot-n Duplicate) al /� pate Issued ------------.--.•�--- Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta te r rest cgescr..ibed. This application is made in compliance with County Ordinance.No. 549. ' JOB ADDRESS AND LOCATI _ _ __%_° � -- -----`bj-,----2--1---- ---- 44 r Owner's Name---------i° ---------- x $j_J '->< ------------------------------------------------------- ---------- Phone- 'I hone , a" Address---=-------------------------------------------------ll'� ��-------�'�'`----- Z - ----------`t`1-T4----------------------------•------•-----•-------......._..--------------- Contractor's Name--------------••--•--•----------.'_ _ ` - -------------------------••-----------------.._. Phone--- ----- ------------- will serve:, Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. --- Number of bedrooms _, Number of baths._,-___ Lot size--____.._ +1 __ Water Supply: .+Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: Yes I, No ❑ New Construction: Yes K No ❑ FHA/VA': Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` P Se ti Tank: Distance from nearest well ___________ Distant from atioq________--------Mat r I____._____ F �. � .c,.,.. _ _ dCJt ----------- ------ p_ No. of compartments______.._ _ - Capacity I Field: Distance from nearest well _____.._.DJ stance from foundation -----e +h Distance to nearest lot line [l --------- Number of lines____________`_ r�L�ength of each line----------�________--.Width of trench_____________ l� r i Type of filter material_ °LGepth of filter material_________,-____._Total length-______-__-_-____I _______--- Seepage Pit: Distance to nearest well____----------------- __Distance from foundation--------------------Distance to nearest lot line___:___.__-__.._ 9 ❑ Number of pits----------------------Lining material------_-----------------Size: Diameter-----------------------.Depth_________...___.__________------- N 4 Cesspool: 'Mstance f-om,nearest well-------------------Distance from,foundation.___.___-__-1_'-_ Lining material___________________._______________- Size: Diameter---------------------------- ---------De th-------------------------------------------- ❑ p = Liquid Capacity-: gals. ` Privy: Distance from nearest wefl-------------1__---------------------------------Distance from nearest building_+_____':______________________._____. n ❑ Distance-to nearest lot line = ----------------------------------------------r--------------------------------- Remodelij_and o pairing (describe): - .... = ------------- 1 w ---- •--------- --------------------------- ------------------------------ ft p ------- --,----- --------- _ �.�_=( i_ = . r 41 p --------------------------------••------------•------• ----------------••----••------- -----•---------------------------------------------- " "` ,r -_; ----------------- I hereby certi, that, I hayt4repared this application and that the work will be done in accordance wr San Joaquin County { ordinances, to ws andVle,�,,,,Xrelations of the San Joaquin Local Health District. (Signed� -- - -----------------` - -------------------------------------------- {Owner and/or Contractor) r ° BY:--------------------------------------------.---------------=--------------------�----------=---------•--------- {Titfe� -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). • r. r -FOR DEPARTMENT USE ONLY {' -APPLICATION ACCEPTED BY---------------------- t ---------------------• DATE-----------= / -- REVIEWED BY-------"-----=---------------------------=-1--------- --------------------------- ---� ------------------------------------ DATE---------------------- ---'= - ------------- BUILDINGPERMIT ISSUED-----=---------------------- =-----------------`------------------------------I----------------------- DATE--------------------------`------------ -------•------------ Y Alterations and/or recommendati ------------------------------- ,o? i _ ----------------------- ---- --- --------------- -= -----`----------��- -•-',5 ------ ---` " ►� E -"` P _. ..` .i�.. --------- -- -------------------------- ---- -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------- --- ----------I--------------------------------- ---------------------------------------------------- T = Date_--------- ---------------------------------- FINAL INSPECTION BY::::___-: -- .� -- - --- - - aM1r.. R AN 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 ;-57 F.P.Co. a _.r ._.. 41%