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r -A1 �' v\_ APPLICATION FOR SANITATION PERMIT Permit No. (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 matte in compliance with County Ordinance No. 549, * � JOB ADDRESS LOCATION---- V41- �-C�. ----- -`-�d------------- 's Name _'_��- -------------- Q ------------------------------------ Owner Phor4 -- T Address------------------------- � �r f e--------- --- --------------------------------------------- -----•--_---------- - -- Contractor's Nam — �9n ' r-- ��----'-------------------------------- Phon I� �- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __Number o aths Lot size ----- - - .-Z ----------------- Water Supply: Public system ElCommunity system E] Private V Depth to Water Tab)& f#. Loam Clay Loam Clay Adobe Hardpan ❑ Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑ y ❑ Y ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest welL1_j0Q____Distance from f ndation---___ to.I.----.Material--- •� No. of compartments-4______________________Size_ __41 __ Liquid depth___ p _ _ Capacity-/.S Disposal Field: Distance from neares well �_�__Distance from foundation----,_0_/_..Distance to nearest lot line_ Number of lines_____ __ _____ _______ Length of each line-AZ .Width of � �� Total length______ Type of filter mate Depth of filter material____!_ __.__.___ . 5---------------- �1 l �___..Distance to nearest lot line__„.__ ____ "\1 Seepage Pit: Distance to neare�t well_�.QQ__.____._.__Distance from foundation______ Number of pits---------------- - -- ��-----Size: Diameter__ +.3��-----Depth-------Z --------------- _ _ _Lining matenal___��Et_.__:. Cesspool: Distance from nearest well-----------------Distance from foundation------_-------------Lining material__.__._______-_____-.-_._-__________ ❑ Size: Diameter--------------------- - --------------Depth---------------------------------------------------Liquid Capacity ----------gals. .. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------.--------------- - ❑ Distance to nearest lot lire- ------------ ------ --------------------------------------------------------------------------------------------------------------------- 4 Remode Ing anci�or repairing scrib }:__ �iti1 L`e -_- eld "' ------------- - --- ---------------.` J .. -------------••------- ----------- ------------------------------- -------- --------•------- --------------------------- --•------ ----- ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , to laws, and rules and regulations of the San Joa uin Local Health District. (Signe _27_---C _- -I9 r mo .._ _ -------------------------------------------- r Contractor) -- ------- - - - ---------(Title)------------------------------------------ --------- (Plot plan, showing size of lot, location of system in relati o wells, buildings tc., can be placed on reverse side). FOR D PARTMENT USE NLY -------------- APPLICATION ACCEPTED BY --------- -- - --- -- -- -- ------------ -- --- - --- -------------------- DATE--- - I REVIEWED BY ------- --------- DATE -~ ------------- ----- r BUILDING PERMIT ISSUED ------------------ DATE------ ------------------- ------•------•------------- Alterations an or rec dations-_ - 1- - ._. i.- . ----- ------------------------------- -------------------- ---------------------------------------- ---------- ------- ------------------------------------------------------------------------------------------------ ----- ------------------------------------- ------------------------ - FINAL INSPECTION BY:...-�-- -- - --------------- Date--- ___�----�-�---��_- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 3o0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 FY CO.