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1D Permit No. _Z_t�--T�--� 1� APPLICATION FOR SANITATION PERMIT Y�11 (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, pp p This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- ------ ----C-7-------9,d__,f- ---------------------------- ------------------------- Owner's Name----- ---6D--------- (! ---- ---------------------------------------------------- Phone----------------------------------- Address---------- --- -- ---- - --------- ------------------------•------------------------ ------------ - ------- ---®--- ------- Contractor's Name---- ----------- ± �-- ----�------ `- - ----------------- Phone Installation will serve: Residence E--'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + r 1 Number of living units: _- Number of bedroo _Z-. Number of bat hs - Lot size _Ilev __ - --r --S---------------------- msWater Supply: Public system �ornmuriity system ❑ Private ❑ Depth to Water Table /0 ft. 3 Character of soil to a depth of 3 fee+:I Sand ElGravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes E] No Ug-"New Construction: Yes El No' [ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T 1 1 (No septic tank or'cesspool permitted if public seweryis available within:200 feet.) Tagk: Distance from nearest well-----------------Distance from foundation-------------------Material_______________________________________________ No. of compartments------ -------------------Size---•------- ---_<_ Liquid depth---------- --------------Capacity----------------------- Dis sal Field: Distance.from nearest well________________Distance<from fou-ndation--------------------Distance- to nearest lot line------------ �-Number of lines Length,of eachrliney `Width of trench .�..... ----------------- .Type of filter material------------------(.-_'_Depth of filter}material-----------------------Total length------------------------------------------ Seepage P' FDistance,to nearest well __ -I_ Distan4 m�f undatio'__-)l0--f___-__.Distance to nearest lot line __. Number of pits______.l_____,____Lining material_ ___Sze: Diameter____.- __-_._.__.Depth__-5`___________________ Cesspool: Distance from nearest well_________________Distance from foundation------_____.__._!"_.Lining material___________-______-----------______. 1 ► . :a ❑ Size: Diameter--------'---------------- ---- Depth Liquid Capacity gals. �} Privy: Distance from nearest well _._____________--------------------_..._________Distance from nearest building-----------------------------------____._. ❑ aDistance-to.nearest lot line-------- --------------------------------------------------------------------------------------------- ------- _ _,.._-----------------------------•--------------------`------- Remodeling and/or repairing [describe]_______________________-_- ----------------------------------------- --------•• S..�x l VV -------------------------------------------------------------------•--------------------------•------ -- --- - ---- ---------------------------------------------------------------------------------------------- .V s ------------------------------------------------- --------------------------------------------------------= ---------------------------------------------------------------------•- I hereby ce that I h prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, S+af 1 ws, and rule and regulations of +he San Joaquin Local Health District. (Signed)------------ V , ` (Owner and/or Contractor) �f, SY= f1� -------------------------------------(Tifle) --- x Plot Ian, showing size of lot, cation of system in rela n to wells, buildings, etc., can be placed on reverse side]. ( P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-Tt'F44A------- ---------------------------------------------------------------------- DATE------ ------------------------------ REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterationsand/or recommendations------------------ /-------------------------------------------------------------------------.___---------------------•------------------------------- )? [a5q`C1 1 3--------------------------------------------------------------------------"------------------------------------ -. ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ------------------ --- --- ------- ----------------------------------------------------------------- ---------------------------------------------------- - - - -Z- -------------------------- --------------------------------------------------------------------------------------- FINAL INSPECTION BY:_ _ ___ _-_._�___ ,� Date.-------- /__/�_7 ----------------------------------- . _ _ _ _ - // SAN JOAQUIN-LOCAL'HEALTH DISTRICT y 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revisea 1-57 F.P.CO.