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ay �� APPLICATION FOR SANITATION PERMIT Permit No. (Complete _-`I.__31_G/-•_--- 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 ---- � - G_- -------fes--� •(_/�--• �s LOCATION:'+ lU -- J! /� Phone----�_.. Owner's Name__ ----------------------------- .---•-•------•-•- -------------------- Fe77 ----- ------------------------------------------------ Phone-----------------------•---------- Contractor's Name------- -G�`•-""'--- - - ------•- - Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel Other ❑ Number of living units: - --- Number of bedrooms _- Number of baths -.4-- Lot size ------------------- Water Supply. Public system A--Community system ❑ Private ❑ . Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p��Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No R�l New Construction: 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.) Septic Tank: Distance from nearest wse�ll --__-Dist e_ ram foundation-__---�-----------.Mate�r_,ial------------------------------------------------- ------------ No. of compartments-----0-='---------------Size_ �-`- t Liquid depth ----- Capacity/r�� Disposal Field: Distance from nearest well___T�---.-Distance from foundation----_-..-------_---Distance to nearest�pt lin��-__.__.._-_. Number of lines-----�--------- ---------- 41 - length of each line---- ------/�---.Width of trench,r-�--�- --- _----------------- �* De th of filter material---- __ --_---_o Total length----7 -------------- - Type of filter material- I� --- p - Distance to nearest lot lin -1je�--- Seepage Pit: Distance to.nearest well------ --- ---Distance from oun ation----- ------ ----,-�~ G Fo-.-- --------.De Dept Z Number of pits--_-_'�--___.____--Lining material��. _- - _ ize: Diameter--- _ p Cesspool: Distance from nearest well__--------------Distance from foundation--------------------Lining material_--_--------------_----__--.-----_---. ❑ Size: Diame'er-------- -------------- --------------Dept h---------------------------------------------------Liquid capacity----------------------------gals.. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---__--_--__--_---__----__.-------.--- ❑ Distance to nearest lot line--------------- ---------- ----------------------------r------------------------------- ----------------------------- Remodelin and/or repairing describe :----___-____ �� « ----- � --•--------------------------•------------------------------------------------------------------------ -------------------------------------------------------------------------------•---------------- ----------------------------------------- --------------- -----------------------------------•----------------.----------------------------•---------------------------------------------- --------------•---- i 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 and regulations of the San Joaquin Local Health District. 0waer.,awd/-ar Contractor) (Signed) f ��✓--"' 1--e� BY: `�------------------------------------(Title) �/�f (Plot plan, showing size of lot, loc on of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------ ---------------r------------------------------------------------------- ------ DATE_�'-� -------------------------------------------------- ------------------------------ REVIEWED BY-------------------------------tet_-- - -- - - ----------------------------------- -------------------------------------.- DA ---- - ------------------- BUILDING PERMIT ISSUED----------------------------------------------- ` ------ ---------------------------------- --�# -----• DATE.------- ----------------------------------------------- - Alterations and/or recommendations:------------------------ - ------------•---------------------- .----•---------------------------------•---------- ------------- --------------------------------------------------------- -------------------------------- -------- ------------------------------------------------------------------- ------- FINAL INSPECTION BY ------------------ Date- .: "' " --------------------------------------------- SAN ---------------------------------- SAN JOAQUIN LOCALHEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-21A . Revised 1.57 F.P.CO.