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r • >- 9 APPLICATION FOR SANITATION PERMIT Permit No. __I_�A__HA... y I {Complete in Du I' ate) Date Issued r7 q ) Application is hereby made to the San Joaquin LocaOHt*j'tb ' s n rape ,� p construct and install the work herein described. This application is made in compliance with County907dinance o. 549. __... v G`( -`----- ----�'' JOB ADDRESS AND LO ATION__,G/ f Phone-------------- -----------------•--- Owner's Name----------------/ v.--------- Address-------------------------� - ------------ z-------- --------- ----------------------------- Contractor's NameYLI�-v`,PI1� 1" --------- Phone 1 Installation will serve. Residence// Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1-__- Number of bedrooms _3-- Number of baths _/---- Lot size Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet• and Gravel El Sandy Lo;--No Clay Loam ❑ Clay E] Adobe Hardpan E]Previous Application Made: Y No VNew Construction: Yes ❑ AA/VA: Yes ❑ No Rf/ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or'cesspool permitted if public sewer-is available wi}hin 200 fee,.} Septic Tank: Distance from nearest well_. -_Dista o found�tion A) ""Mate ia4-_ - - �� --- -- - -- No. of compartments-------0------------- - -- --�#.-.�L_Liquid depth------- ------- ---Capacity------- ------------- - r --fir Disposal Fie4d: Distance from nearest well._q_ 'Bistance fro oundatio _ ��Distance to nearest lot line_ ___7?`n'G+-�. Number of iines_______ C__ -- -- �jLLength of ea�cir4e� _ --_.Width of french-___- _ ------------ Type of filter mial_:-s ------- of filter material_-_-- _?_`_______Total length----- -------------•---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- Fl Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------------------- \ Cesspool• Distance from nearest well-----------------Distance from foundation_-----------------Lining material------------------------------_____- ❑ Size: Diameter------------------------ ----.---------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------_--------.. ❑ Distance to nearest lot line----------------- ----------- -•---------------------------------------------------------------------------- Remodelinand'/or,reairin describe -----------------------------------•-----------•------------------------------•-------------------------------------------------------- ----------------------------------------------------------------- ---------------------------------------------------------------------------------•----------------------------•-----------------------------••--------------------------------------------------7---------------_------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County } ordinances, State laws, and rules and4regulations of a San Joaquin Local Health District. Si ned -------------------(Owner and/or Contractor) { 9 ) --- By:-------------- .-------------- - ---- -- ------------------------------------------------------------------ Title - ----------------------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). tFR R� T &NEON APPLICATION ACCEPTED BY----- 1----.- ---------------------- ATE----- -7 REVIEWED BY------------------------------•---- --------------------------------------- DATE 1 - BUILDINGPERMIT ISSUED-----------------•---------- -------------------------------------------- DATE------------------------------------------------------------- -------------- Alt do s and/ commendation --------- ---- ------ ----- --•---- ---------------•------------------------------------------ `:_:--------••----------------------...--.------------------------•---------------- 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 a 1 ES-9-2M Revised 1-57 F-P.CO-