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f � APPLICATION FOR SANITATION PERMIT Permit No. .'`f_ -�.J_-.._ (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 here' d. This application is made in compliance with County Ordinance No. 549. 19T /�PF/ C Q J08 ADDRESS AND LlO/CATION f _- `Sa A T - -- ----- p �� ; Owner's Name----------z57 4_TT -------�r C -�-------- -------------------------------------------- Phone-------------------- .-- -. Address--------------/_VT------- / ----------- ----------- /- ----------------------- Contractor's - /---- �/ - Contractor's Name------------------- /_ -�j ---------------- Phone.C!_1?-/-_9'_,K ------- ��, ------------------=----- --- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑. Other ❑ i Number of living units: Number of bedrooms --/-- Number of baths _1 `� aQ --------•-------- ----- --- --•-- Lot size ------------d-- ----•----•-- Water Supply: Public system ❑ Community system ❑ Private [J} epth to Water Table /*_,ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No [9-�New Construction: Yes [r7a❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance from nearest well-_�----__--Distance from foundation__-, -D�.-.--__.Material_� _��-__ !.C '____-__-. �k i u/ No. of compartments------- -------------Size--SL. G ----------Liquid depth-----1/. ---------Capacity.X AD^,�rt--- Disposal F- Id: Distance from nearest Distance from foundation---.l-Q_---------Distance to nearest lot line._---- --_. Number of lines---------/--------- -------------Length of each line____----- _Q-_-----_-----.Width of trench.----�r/_r_-_------.-----___--- d Type of filter materiaL�.___po�---Depth of filter material--- -g�____---Total length___-- a------______________________ Seepage Pit: Distance to nearest well_---------------------Distance from foundation--------------------Distance to nearest lot line--------.--__---_ c ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------------- to Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------._-----------.--- 1 ❑ Size: Diameter--------------- --Depth-------'-------------------------- -----------------Liquid Capacity-------------------------..gals. Privy: Distance from nearest well-----___------------� -------------Distance from nearest building--------------------------------------- 171 Distance to nearest lot kine------------------- •---------------------------- ---------------------------- I f Remodeling and/or repairing (describe):---------------------------- -- ---•-------------•--------------- -------- -----------------•- ----------' ------------------- -----------------------•-------------------------------- ------- 4 a i. k --------------•-----------•---------•---------- - ---------------------------------------------------- ItI------------------------------------------ 't ----------------------------- - - ------------ - - - ------------------- ------ - ------------------------------------------------------------------------------------------------------------- -- - I here- by certify that- ----- - I have prepare- - -d this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of'the San Joaquin Local Health District. + ------------------------------------- -------------------------)Owner and/or Contractor) (Signed) '/S Sal7s T , II Ti#!e ---------- --------------------------- By---------------------------------- �� Mill -- -�-------- --------------------------------- ---- - { } (Plot plan, showing size of lot cation of systZ in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -----�-------- - G DATE . - ----- /// -- APPLICATION ACCEPTED BY -.-__ REVIEWED BY--------------------- �-� DATE BUILDING PERMIT ISSUED•------•----------------- - - - DATE Alterations and/or recommendations: -------•----------------------- - --'----------------------------- ------------------------------------------------------------------------------------------------------------------------------- --- -------------------------------- FINAL INSPECTION BY -- _ �� - ------------------------ -- S N 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 1.57 F.P CO-