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f APPLICATION FOR SANITATION PERMIT Permit Na. _,__a---------------- (Complete _"f_=------[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. S JOB ADDRESS AND LOCATION__ _`__$- -�� 6------------------------- ---------------j - --- ------------------------------------------------------- ----- Owner`s Name �`•- hone- �-' -' tAddress------•-----------------•------------------------------------ 'Un11�-------------------------------------------------------------- i Contractor's Name------------------- -------------------- -------------- ------=---=-- Phone._- (j�-�� Installation will serve: Residence 1,:;kA artment House Commercial ❑ Trailer Court ❑ Motel [I Other [I ., ., �r i• -r_--'-._�i__ °7, h�y..,..,L.,,� ,. h Nnm}�Pr nf,hAths - Lot 5ize --------------- --------------�_------------ :: J j/ ---------T aavatc Address zk, Character of soil to a depth of 3 feet: Sand L] Gravel ❑ Panay L-oam LJ UFa a " yCuty' Previous Application Made: Yes ❑ No D 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.) M� :7 Septic Tank: Distance from nearest welll_a_____-Distancefrom foundation_____ _.Material____Size �X=� ''�- --- ------ apacity_.-�_Z_C_D ` No. of compartments__--__ ___t_- �� Liquid depth_--- _._____. r ------- Disposal Field-: Distance from nearest weil_�-------- Distance from foundation----)(____-___-Distance to nearest lot line---- ----- -------- i P Number of lines---- -------------------------Length of each line---�V-j----3P1-30-.Width of trench-----Leal-�--------------------- j= Type of filter material--# yr _.-__._-__ Depth of filter material`�:_.1_g!!_-___i r-Total length______ ------------------------ or ________------------- 4(1l1�t V j. +�.........��....�.�.. vim..._.. .. y�v c""r' Seepage Pit: Distance to nearest well----------------------Distance from foundation___:_.._-________..Distance to neo h-----of line_____-____.______ ❑ Number of pits------ ---------------Lining material----- -- ------------Size: Diameter---------- Depth \ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining ❑ material__--------________---------________. � Size: Diameter------------------ ------------ Depth------'---------------- --------•----- -------_Liquid Capaccty---------------------------gals I r ________._Distance from nearest build - " - _ - Privy: �- ---=-- ------------------------------ Distance from nearest we ---------------------------- -- --- ❑ Distance to nearest lot line---------- ---------------------- ------------- ------------ --'-- :� � w ----- %oun Remodelin and/or re it n (describe):_-_-- --- ---�-- �------- - - -- - - F V x ------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws a d �Iesand egulati 's of the San Joaquin Local Health District. -ti i. -. .._._ I � Contractor] Si ned ------ ---------------------------------------- Owner and/or Co or] Title By:----•------------ ------ -------------- •-----------y----------- --- -- ] --------------------- -- [Plot plan, showing size o t, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �" ----------------- DATE '. � 1 - ' REVIEWED BY. ------------------------------- --------- DATE l BUILDING PERMIT ISSUED---------- - -------------------------------------------------------- -------- TE e_ p. w � -------- ------------- Alteratio and/or ------ recommendations:-____-- _. �-$, - a�--z- � /,{, rte '' -- - _ 1 �� ' b- - - - -�-r4 - ��} �� --------n tw------- - ------------- ---------- -- t_ x. FINAL INSPECTION BY------- ---- -------------------------------------- ------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, Cal;fornia Tracy, California .E5-9-2M . Revssea 1.57 F.P.CD.