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APPLICATION FOR SANITATION PERMIT Permit No. .l�_�_-G�_ (Complete in Duplicate) Date Issued --------------••-__---- Application is hereby made fio the San Joaquin Local Health District for a p �yni0to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �'` JOB ADDRESS AND LOCATION----- - --------6------- GtJpS- - (� - Y _r1 C=-- C�� .-- , ✓ -- Owner's Name__'_ ______ -_______ Phone--------------------------------•---I/------------ --------------------- ---------------------------------------- -- --------------------------------- Owner's Name-Ay, ----------------�5'`"' Contractor's Name.------------ X,eLe-1-------------------- ------ Phone-------------------------------- --- Installation will serve: Residence X Apartment House [-] Commercial El Trailer Court [__1 Motel El Other 0 Number of living units: I---- Number of bedrooms _..__ Number of baths _______ Lot size _A5.O__x.---;? -------------------------------- Water Supply: Public system ❑ Community system ❑ Private §4 Depth to Water Table ' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: Yes SK No ❑ New Construction: Yes ❑ No FHA/VA: Yes [7 Noll' TYPE OF INSTALLATION AND SPECIFICATIONS: ''� X (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic mak: IC istance from nearest w 11_ �_�)_____DistanceefroT foun ion_____ 0---Material___` "- -------------- o of compartments_._____ ._-Size__ _-. -_ Liquid depth___�/_�_____.___ _ p i 8 {' Capacity �� C' Disposal Field: Distance from nearest welL_ .(�r ------Distance from foundation.-__- _____ __.Distanco to nearest _ 31Number of lines___._-A?, Length of each line---IS-!4-__.Width of trench _- Type of filter material V___--Depth of filter material.. ,91 total length s� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_------ ___--___ ❑ Number'of pits----------------------Lining material- ------ _ ----_-_-____________------ .Size: Diameter----_------------------Depth--_-- - C' ' n Cesspool: Distance from ne ra est well-----------------Distance from foundation--------------------Lining material------------------------------------- 7 ❑ Size:_.Di ma eter----------`-------- ----- ------------Depth------------------------------- ---------.-Liquid Capacity-. Privy: Distance from nearest well____--------- --------_---------------------Distance from nearest building_____________._________---------- -----. ❑ Distance to nearest lot line--------------------------------------------------------------------- r Remodelingand/or repairing (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 and regulations of the San Joaquin Local Health District. (Signed)- a ------------------------------------ -----------------------------------------------------------(Owner and/or Contractor) BY:------f--•- ------------- --------------------------------------------------------- ---------------------------------------------(Title)-------------------- --- - ------------ - ------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ----- - ---- --------------------------------------------- DATE__ REVIEWED BY......----------------•------------ - --- -- - -------- DATE------ - / - I BUILDING PERMIT ISSUED---------------- --- --------- ------ DATE------------------------------------ k Z Alterations and/or ec mmendafions________ ______ ___ _ ___- --------- 4 ____ - -- -- ------------- -------------------------- - ----- -------------------------------------------------------------------------------------------------�------------------------- 7Z FINAL INSPECTION BY:.. ll- --------------- -----rte '------------------- Date 4�` ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1.57 F.P.CO-