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.A" � APPLICATION FOR SANITATION PERMIT Permit No. -1:10-- -�----- c x' (Complete in Duplicate) Date Issued 3 �¢ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the walk herein,described. This application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AN LOCATION '_: ._, =s� % }' --- ------ = = '= - - -------------- Owner'; Name------------ - ---- - ------------------------- --------------------- one r Address �, i x !( J� .? -.--.r_�c =Q ,� -------------- i:: c= '"' - ---------- Contractor's Name-------------------•----' ----------------------- --------------- Phone------•---------------------------- Installation will serve: Residence ©-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-./-__ Number of bedrooms _1----- Number of baths __J___ Lot size ------ __;_._a'.. °_±_ _____________________________ Water Supply: Public system ❑ Community system 41;�'_'Private ❑i -Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2-'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: IN eptic tank or'cesspool permitted if public sewer is available within 200 feet.) ept -nk: Distance from nearest well__!'"-_..-____Qistance from foundation__.___1____-_---.Material-------:__:-------____________ __.__,._._____. -----------Capacity -- ' No. of compartments.__.__�.•�-------------Size__'t"_K.�K�+- --._._Liquid depth-------',=__-- p ty___--� =------__-•-• 1 Dispo al Field: Distance from nearest well__r�j---------Distance from foundation_____'------------Distance to nearest lot line-----..----- j� Number of lines.----•-• ---------- --- -----------Total length-----_-----Length of each line -------------.Width of trench__--k--_;;---------------------- _/_ '�-_1 Type of filter material--- `k0---____-_-_-Depth of filter material-_---- ---------- Seepage Pit: Distance to nearest well__.__..---------------Distance from foundation----------_---------Distance to nearest lot line----------------- ; ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- ! Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---------------`_-._-------------- r ❑ Size: Diameter---------------------------- ---------Depth--------------------- ----------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----__--__-_.--------_-____------_----�, i� ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/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,+State laws, and rules and regulations of the San Joaquin Local Health District. x {Signed)-- f='�s� ' - =- --r_. f= �J - {Owner and/or Contractor) By:__'-------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------- -------------------- (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 art il.�;�,,. t APPLICATION ACCEPTED BY-------- - -r°------------------------------------------------------------- DATE y'----- --- --- -- - -- ---- REVIEWEDBY--------------------------------- ------- ------------------------- ---------------------------------------------- DATE-----------------------------------_---------•------------ , It VG,,PERMIT-ISSUED_^:... �A ------------------------------------------------ DATE`--------------------------------------------------- Alterationsand/or r commendations:------------------ -------------- ------------------------- -------•--•-------•-------------------------------------------------------- ---------------- ------------- --------- 7777-- -�- ----- --- -- ----- ------ 40-141'"--------- - --------- - :.: _ ------------------- ------------------------------------------------ ,�- %<�1'17 FIN �! PECTI .-------------------------------------- ----------------- Date---- --------------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT t 1310 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1=S--4-2M Revises 1-57 F.P.CO.