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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) t�y J Date Issued ---- �S9_ 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 LLOCATION...3jo-j/7---r4Yf'f22i� l..d -- ra__ --...-•-----.551/1 _..----------- -----------------,-------------- Owner's Name------------ f-111co------ --------------------- --------------------------------------------------•---- Address-------------------•--- '27�r1,&- -----• ---- -- - Contractar`s f ' /�t�--_�2 , � '.`:�. r ! �� Phon . _. �` Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -3--- Number of bedrooms _ Number of aths ...�__ Lot size _____ _-_-_ � ►_�q________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table "dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Tlardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No HA/VA.. Yes ❑ No Ejff� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se"'Ta :, Distance from nearest well-- -----------Distance from foundation-------------------Material--------------------------------------_-____.___. No. of compartment-s--------------------------Size----------_-----------------.---Liquid depth--------------------------Capacity--- L' spyoossal Fi Id:j Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--__-_________-__ �rtt Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material--- ---------------------Depth of filter material-----------------------Total length----------------.------------------------- See a e Pit: D�G�s#3 is +e o nearest IC`_!J_O__-______Distance from foundation_/*"(0_*"_-_..Distance to nearest lot line-___L-_- _ Number of pits--.--/---_----- -__Lining material_RoA--___-__.Size: Diameter-_. �f____Depth--- _ --_____-____-_. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ \� ❑ Sze: Diameter Depth----------------------------- ---------------------Liquid Capacity------------------------ gats. V Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________.______..________. ❑ Distance to nearest lot line----------------------------------- ------------------------ -------- --------------------------------------------------------------- Remodeling and/or repairing (describe):----- sr -------------------•-----------.-----•----•---------------------------------•--------------- I!----—-------------------- --------------------------------------------------------------------------------- ----------------------------------------------•--------•---•----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signe ---------- Contractor) By:.--------- --------- ----- ----------------------------j�elafrion --------------------------(Title)-----------------------.---------------------------------------- (Plot plan, showing size of lot, location of system to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ --------- -------------------------------------------------------- DATE---------- -- �-----••----••------ REVIEWEDBY--------------------------------------------------- -- - -- ---------------------------------------------------------- DATE-- BUILDING PERMIT ISSUED---------------- -- ---- - ------- - DATE----� - .._ Q-__ --Alt tions and/or recommendation �_ e"C'---- --- - ----------- _ - ------ -- - - --- - r-a---------- FINAL INSPECTION BY:-- . ..... - --- Date-l---- I___�-_-`5_---7'--------- ............... AN JOA�QUIUIN -QCAL HEALTH 17I RIOT �� 130 South American Street 00 W' Oek Street oG�v _ M Sycamorelfreet ala Narrh C Sfreef Stockton, California Lodi, California Manteca, California Tracy, California LS--9-2M Revised 1�57 F.P.CO.