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..,' , !k APPLICATION FOR SANITATION PERMIT ; Permit No. CO--Z-'U---- (Complete _Z`{t_____(Complete in Duplicate) gip/y /L- Date Issued .__/__-----`7------- 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 LOCATION,--`� 7 J-� " 45------------------------- -------------------------------- Owner's Name �C ---- ' ----- -.-- Phone------------------------------ l Address--------------4$-jo ------G=-- 0 - - I Contractor's Name------- -------------------------------------------------------------------- ----------------------- ---•---- --- Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other E]Number of living units: _/_____ Number of bedrooms __I_____ Number of baths ---I--- Lot size -.1-4--X_---16_1c)_______________________________ Water Supply: Public system 1�' Community system ❑ Private ❑ Depth to Water Table -------- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeV Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 14 No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from.nearest well_-_--�evf�istance from foundation---1-i?---------Material-"RX-a ________________ No. of compartments--.___- ----------------Size---- _ _ _ ---Liquid depth---------- _--_Capacity_____ Disposal Field: Distance from nearest well�_OR,-_Distance from foundation----!_4___ ___.Distance to nearest lot line---- ►'___--_____ Number of lines_____„ Length of each line IX) ____1__Q_________________Width of trench_{_�___ _____.________.-__ N Type of filter material__---__-- __ t.�lth of filter material___ -l-$_-----------Total length-------EQ �__.____________-____-_._ J i Seepage Pit: Distance to nearest ---------------Distance from foundation--------------------Distance to nearest lot line______________.__ ❑ Number of pits-------------------Lining material-----------------------Size: Diameter-----------------------.Depth-_---------------------------------------------------------- Vill Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- '❑ Size: Diameter----- I------------------------------De th----------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest'well-------------------------------------------------Distance from nearest building___-_____.___-------.-________________._. •�(}! ❑ Distance to nearest lot line-- ------------------------------------------------------------------------------------------------------------------------- C 7 i Remodeling and/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, S to laws, and rules and regulations of the San Joaquin Local Health District. t ° # 1 (Signed) ---- --- -- (Owner and/or Contractor) --=------------------------------------------------------------------------------- I +wiy. . By:- ---------------------------004 ---------------------=-----------------------------------------------------(Title)----------------,------------------•------------------------- I (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 APPLICATION ACCEPTED BY--- -------------------------- --------------------- ---------------`----------- 4------- DATE......... <; REVIEWEDBY-------- ------------------------------------ ------------------------------------------------------------' DATE BUILDING PERMIT ISSUED------------------------ ---------------•--------------------------------------- DATE---- �� 1 11� Alterations and/or recommendations: - --- - ......... ----- ------------------- -------- .k----------------------- --------------------------------------------- -------- ---------------------•-- - - - FINAL INSPECTION BY:. �--- 4--- --- -------------------- Date --------------------------------------------------------- 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-9-2M Rev;sea 1.57 FP.CO.