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1 -7 APPLICATION FOR SANITATION PERMIT Permit No. __- _.1_......... (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. ' L'(..4 o,-A--0 o _ST ' r I JOB ADDRESS A, LOCATTION...� ---------FY_.-_�fi')--r-------- Owner's Name-- �l -----'---`----------------- --- ------------------------------------- -- Phone------------------------------------ Address----------------------------------------------------------------------------------- `+ -'t 1,a✓ ------------------------------•---- ------------------------------------------------ Contractor's Name.-- ----------------------------------------------------------------•---------------------- Phone------------------ ---•-- Installation will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-_____ Number of bedrooms __3_ _ Number of baths I--- Lot size 99W ;2�__A�-4)----- Wafter Supply: Public system ❑ Community system ❑ Private)K Depth to Water Table _30 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamX Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 5( New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: eptic tank or cesspool permitted if public sewer is available within 240 feet.)J 5e is Distance from nearest well----____Distance from found _ ___.Ma+erial_ 5•-7"-'i' _ r --------------Dsosal Fdo f compartments--:-,R- Size---7.X- Liquid depth______ Capa Distance from nearest well------ from foundation__Z_0_!_.__._.Distance to nearest lot line___ Number of lines-------- - -- - --------- __ __ Length of each line_ 0__�_______-__-__.Width of trench-----p__ -. r Type of filter material_ _ r __ Depth of filter material____ __ ___________Total length_____-)_;4---------------__,_-___._ - Seepage Pit: Distance to nearest well_----------------------Distance from foundation____________________Distance to nearest-lot line_____-.._--____ c' ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------,------------------ Cesspool: Distance from nearest well------------- from foundation--------------------Lining material-------------------------------------- F1 ___.______________--_-_-----_--. -❑ Size: Diameter----------------------- *'---Depth-------------------- -----------------------------Liquid Capacity----------------------------gals- Privy: Distance from nearest well_______________________________-----------------Distance from nearest building----------------------------------------- Distance _______-.______________________.__ .-Distance to nearest lot line---------------------------------------------------------------------- ------------------------------------------- ------------------------ f Remodeling and/or repairing (describe) __--------------------------------- ----------------------------------•------------------------- --- _-1------------------------------------------------------------------------------------------- --- ---------------------------------------------------•----- ------------------------------•----------------------------- -'1 ----------------------------------------------------------------- --•------------------•-•---------------------- ---------------------•-----•-•---• :--------------------------------.--------------------------------- -----------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------- 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)---- ----------• ----•--------------------------------- �Q---�/�r----(Owner and/or Contractor] A. E�-- sy:... �' t � -- ------------ ' �4 {Ti+le� 1 --------------------------------------------- (Piot plan, wing size of of, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ----- ----------- ------------- ------------------------------•----------------------- DATE REVIEWED BY-------- ------ ------ -- - ----- --- ----�--- -------------- ------------- DATE ?? --�� BUILDING PERMIT ISSUED---------------------- -- ---- ---- --------- --------- ------------------------- DATE Alterations and/or recommen tions: ----------- ------------------•----------- ------- ------------------------------ ------------------------- �d �/ ---------- --------------------------------...----.------- --------------------------------------- ----------------------------------------------- ----------•------------------------------------------- --------------------------------------------------- ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- '94 FINAL INSPECTION BY:- f_1---� . --- = --------- ----------- Date(.'_ r 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 RP.CO.