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l � _ APPLICATION FOR SANITATION PERMIT Permit No. .._/..6 5Z. (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 . JOB ADDRESS AND LOCATION---'_`_ fl. -________LeCf1___ -_ r Owner's Name_ ! _ -------------•---------_�_�! +1`,- P A, _. �. :, =------- -----------'----------------- ---------- -- -- hone----------------- ----------------- r ' � Address = ------- -------`-------------- - -------------------------------- -----_----------------- Con fracfor's ----_----------------.Contractor's Name------------------P�/%j s- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Oth1 ❑ Number of living units:y_ __; Number of bedrooms .-/---- Number of baths -_/-__ Lot size t__ - - -----"-------_-----------_ Water Supply: Public systemFf❑ Community system ❑ Private ❑ Depth to Water-Tablet. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam ❑ ..Clay Loam ❑ Clay ❑ Adobe [+Hardpan ❑ Previous Application Made: Yes No I pp ❑ [� New Construction: Yes ❑ No 0�FH/A/VA: Yes ❑ No [,� TYPE�OF INSTALLATION AND SPECIF[CATIONS:L f (No septic tank or'cesspool perrnitf.ejj,if pub c sewer is available.within 200 faa.), Septic Tank: Distance from nearest w II'_____ Distance from fopnda)ion__��___._-_-Mater - 1_-._ i No- of compartments___-- - ;-- _ Size---"---A,�-A� �:---Liquidde'pfh--------- ----------------Capacity--- Disposal apacity---�----�---pDistance from foundation_____� Dis osal Field: Distance from-nearest _______.Distance to nearest lot I'7P_____,_._._____. Number of.lines_--=_------- g ' ' _��'_iLen #�h�ofreach-.line______ .-G Width-of.trench-_ �-�_________-._ r Type of filter material____ Depth of filter material__._ ___:______Total length___-__ Seepage Pit: Distance to nearest well___________________--Distance from: foundation--________________.Distance to nearest lot line_-__-^a________ ❑ Number of pi,is----------------------Lining. material------.----------------Size: Diameter------------------- --Depth_------------------------- Cesspool; , Distance from nearest well_________________Distance from foundation--------------------Lin ing.:material___.-__-----_--_____.____-_______- Size: Diameter----------------------------- -----Depth----=------------------------ ----------------------Liquid Capacity- gals. Privy: Distance from nearest well____------------------------------------------.-Distance from nearest building-------------.------------ ❑ - -Distance to nearest lot Iin�-------- ------------- Remodeling an /or repairing [des iL�e�: `= __ _( ------- -- -- --- f! -- -- -- -------------------=- ,4 T { v I hereby certify�thaf 1 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. (Sig )--",-----� ---VIP ------------------------ --------------------------------------------------------"-----------------------(Owner and/or Contractor) 8y:. ------------1......--------- ------ --------------------------------------------------------------------------(Title)------------•---------= =------------------------------------" (PiotIan, showin y p g�size of lot, location ofa stem in..relation to wells;'buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - -A-----/------------------------•---------•----------- DATE--------------- ` - -REVIEWED BY ------------ -- - % - �--------------------------•----------------•--- DATE------`-- -2 -- -----------------•----------•----- BUILDING PERMIT ISSUED------_------•-----•-- �------- -------------------------------------------------- DATE----------------- ---------- Alterationsand/or recommendations:------------V---------------------------------------------•---------------------------------------------------------------------------------- ., 4 ----•----------- --------------= -------- ------------ = 1 ________________________________ ______________________________ FINAL fNSPECTIOBY:_ = = Date Z- ----- N i=- ---------- ------------------------ SAN ---------------------- ------ ~ ,-r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street v 132 Sycamore Set } k'^- 814 North "C" Street Stockton, California Lodi, California Manteca, California ! Tracy; California I ES-9-2M1 , Revisea 1.57 F.P.CO.