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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND Lg.C.ATION-------------- I------------------ V -----------------•-------------------------------------------.------------------------- Owner's Name-----------r �/• � x/06 - ------------------------------------------- /"�'�' "0 � Q.c�.t-�-��------------- -- Phone-- ----3--•--- .S�17 Address---- ------------- a� + vl D -.------------------------------------------------------------ ------------------------------------------- Contractor s Name---------- --`--ec7� ----- V >�°QQ �1�` Phon 1 1 '�er�•� ------------ Installation will serve: ResNience [R-'A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ ber of bedrooms ___Z-Number of baths _- - ---- Lot size ------------------------------------------------------ -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,50- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construcfion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 40d Sepfic•TannRk: Distance from nearest well-----------------Distance 'from foundation--------------------Material------------------1 _________.__-_____. .: r No. of compartments--------------------------Size--------------------------------Liquid de th-----_------.------------_Capacity Disposal Fiel ' Distance from nearest well----? -Distance from foundation_ _!�!- __._______Distance to nearest lot line_.---_---__-_--- Number of lines-------1----------- -Length of each line___ Width of trench---a9!e_________________ _ Type of filter material---✓'p_C 7________Depth of filter material-.J--r`*_f_____.-Total length____3L&_/____________ Seepage P y- Distance to nearest weal----k!r `''"'___Distance from foundation_,/a_-------.-..Distance to nearest lot line----------------- r ° QNumber of pits----I-----------------Lining material----r"QGL --------Size: Diameter____ --------Dept h---,PX�----------------- 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___________________________-_________._. r ❑ Distance to nearest lot line--------------------- Remodeling and/or repairing4 describe):----------------- _ -----=-------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------•----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ? 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 d regulations of the San Joaquin Local Health District. ►, - -- �- ---- -- ---------- ------------------------------------------------------------------- and ar Contractor [Signed)----------------�_ p --- - B p�-e { / ) f -------- ._ �AG7�U� (Title)---- Owner IBY� { �------ -------------------- (Plot plan,,sho n size lot, Iocation of system in re as ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . ' APPLICATION ACCEPTED BY--------------------------- -- ---------•-----------------•---------------------------- DATE ^ I° REVIEWED BY -- -------------------------------------------- ----- DATE---------- � I BUILDING PERMIT ISSUED-------------------------------- ------------------------------------------ ---------------- DATE---------------- ------ --- Alterations and/or recommendations:_____________________ _ .______° 4 --- i ------------•-------- --------------------- .t - -----..._.. .. _ ,_. -----------------------------------------•-----------•--•----------------------------------- kk _19- ------------------------------------ - -- - ------------------ -- -------- --------------- ----------------------------------------------- ------ FINAL INSPECTION BY:--- --- -- ----- - -------- --- - -- Date------------ ---------- - ---- ----- ------------------------ SAN .JOAQUIN LO-: HEALTH DISTRICT 130 South American Sfreet ri 300 West pale Street 132 Sycamore Street 814 North "C" Street nr : .w.. Stockton, California. Lode, California Manteca, California Tracy, California ES-4-2M Revised; 1-57 F:P.CO.' 4 i'