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I li APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __-_f ' 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. 549.1 JOB ADDRESS AN OCATION..._ 3 W------ p—� ------------------------------------------------------------------------------------- Owner's Name---- -- ------- R •---- ------------------------ - ------------------------------------------- Phone------------------------------------ Address----------------- ' —------------------------- i Contractor's Name---------------------------- ---------------------•---------------------------- --------------------------- --------- Phone----------------------------------- i Installation will serve: Residence ..Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,�_ -- Number of bedrooms Z---- Number of baths 4---- Lot size i-®---______-__-_-_-_______-___ Water Supply: Public system 7+ Community system [IPrivatdDepth to Water Table .3Z ft. s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ AclobaN Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No' HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or'cesspool permitted if public sewer is available; ithin 200 feet.) Sep • Tan • Distance from nearest well-------- -______Distance from fouidation--------------------Material-------------____----__________----______------- 5 No. of compartments---------__-------F- ` Size-------------- -----------\Liquid depth----------- ------------ Capacity r Disposal Field: Distance from nearest well.._.___.--__Distance from foundation'____________________Distance to nearest lot line---------------- Number of lines--------------------- .Length of.'each line' - 4-______------.Width of trench---------------------_------------ - Type of filter material :y�,l _ e h,.of filter materialA---------------------Total length------------------------------------------ Well ___-_----.___________._______________-- Seepage Pit: Distance to nearest well__;*5567o_.__:_ _ "_Distancef o foun ation____�Q;+___.Distance to nearest lot line__._ Q Number of its_________I----------Linin imaterial�_a�' p. f 9{_ ¢e: Diameter - .Depth Cesspool: Distance from nearest well----.--------._____Distance from foundation---_____________---_Lining material--------.----------------------------- ❑ Size: Diameter_____________________ -- ------------Depthi----------------------------------------------------Liquid Capacity----------------------------gals. Distance from nearest well f 1/' Distance from nearest building-------- Priv ❑ Distance to nearest lot, line---- ---------------- Remodeling and/or repairing (describe):--------------------------------------------•---------------------------•--------------- ---•- ----------------------------------- -------------------- - ------------------ {- -••---------------------------------- \\ - t k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed)--- -__--___ . _ _____, (Owner and/or Contractor) _�� B �----- Y• (Title) ------------------------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed.on reverse side). FOR DEPARTMENT USE ONLY i - P Y-- ------ ----- ----- -- - -- --------------------------------------- DATE------# ------ ------ APPLICATION ACCEPTED BY______________________ REVIEWED BY------ - ---- -- ------=-----1------- DATE---- '- -!r_.. ie------ BUILDING PERMIT ISSUEDR - DATE-------- Alterations and/or recommendations:----------------------- Y{ - ------------------------..,.-- ----------------------------------- �!�4 - S..- ` is z ------- ------ - ��:�------ �------.G'Z.G(J ,7�,4z----^-- - ._ ._��x -----•-------------------- ---------------------------------------- ------------------ -------------------------------------------------- ------ ---------- - - - - ------------------ FINAL INSPECTION BY-------------------------------------------------j!77-3 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.