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1 APPLICATION 4FOR SANITATION PERMIT Permit No. - 40 (Complete in Duplicate) ., ' N 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 compliant , wit County Ordinance No. 549. s JOB .�: - 9 ADDRESS AND LOCATION___-_'- -_I'-5-�°��_`____-_-- ----------- "'+-------------------------------------------------------------- - ---�-------------------`----------- --------- Owner's Name, --------------- -- --------- ------------------------ .-�?1-f Phone--------------------•-•------------- '']� ,� C/ � Address � c" -f- � °�'f •' --------:- Contractor's Name------- ---------- ------•�- ---- ! x '>tscyit.---- -----------------------------------------•--- Phone----__-------------- ------- Installation will serve: Residenci[V�Apartnient Mouse ❑ Commercial ❑ Trailer Court ❑ Mo--->�ot I El Other Elr.__ Number of living units: ___ umber of bedrooms ._Z-- Number of baths ___1___ Lot size __0 __r_ao__r______----------------- i Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes E] No [v] New Construction: Yes ❑ FHA/VA: Yes ❑ Na ❑ TYPE OF INSTALLATION AND SPECIFICAilONS: (No septic tank or cesspool permitted if ubli sewer is available within 200 feet,) Distance from nearest well__Distance from foundation_-_ Material._/� -------- Septic/Tank: No. of compartmenfs----------ZJ-__ -- --Size-----------------`---�"------Liquid �epfh--------------------------Capacity----- -,��----- Dispos Field: Disfance from nearest well-&I" Distance from foundationif) _.Distance to nearest lot I' S?S4 rte✓ Number of lines__________._ _ __l______Length of each line__________ - Width of trench__._ _ __ �' '�'------ }J Type of filter materi _ ,hti'�` epth offilter material__----�_ ---_�---Totaf length_________ _____ _ Seepa e`Pit: Distance to nearest gell�____ .x_.F: ______Disfance from foundationtg�_L_7 0istancelto nearest lot line_��__r� �_ Number of pits--------1------------Lining material---- ". '�_-----".Size: Diameter------ ;?,a------ Depth-------t r 7----------------- w Cesspool: Distanceifrom nearest well_______,_—_:Distance from foundation.-._ -____-__.-__..Lining material___________________________________ I(� ❑ Size: Diameter------------------------ Depth------------------------ --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________________________--_-__-----. ❑ Disfance to nearest lot Iine------------------------- ---------- --------------------------------------•------------------ -------------- ------------------- Remodelinghd/or ,repairing{ ------------------ -----------------------------•---•---------------------------------------------------------------------------------------------------- �4 ,Q�----------=-------------------- s ----------------------------- -----------------------------------------------------------------------------------------•--------,----------------------------------------------------------------------------------------- -------------------•--------------- --------------•--------------------------------------------------------------------- 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 Joa uin Local Health District. BY= { Owner and/or Contractor e)�-- -------- ---------- - -- ------ ------------Si ned �itl (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 APPLICATION ACCEPTED BY ? DATE:----------_----------------------------------•---- REVIEWED BY ---------- ' DATE__-BUILDING-PERMIT ISSUED-------------------------------- -------------------------------------------------- DATE--- - --------------------------------------------.._-. "/ f R Alteratibhs m � w , -------------------------------- .-•--------------------------- --•-•------•------••-------•----------•-•---------------•--•------ . -----------•----------------------------------------------•------------- ---------------------- --------- .-__.............----" ,-------- ---- } , -E ►1 ----------= ___7--X-V,�,pl------------- _Aj/----- FINAL INSPECTION BY:----� -�, Date____71 -�__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California —9-2M Revises 1.57 FY CO.