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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Y 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. Q r. -/70—CJs �! ------- --- T, JOB ADDRESS AND LOCATION__.- S:` " ''-"`r_ -----Oak-------f1�-`'--)---- -- ----- Owner's Name-------JMY7-----------()------------- e •--------- ---------------------------------------------------- Phone- 1V 1 ,7 7 Address--_-------------- �------ik -�--�----' -23.Y.--� - _ t --- •`• -- - Contractor's Name--------------------------------- ----- ------- ----------------- - ------ ._2 c -- :_-----!--_ P(h ne"�` Installation will serve: Residence ;Apartment House ❑ Commercial ❑ Trailer Cgurt ❑ Mote( ❑ Other ❑ f- Number of living units: _I__.___ Number of bedrooms -1--_ Number of baths __�_____ Lot `size _ ___}�_�Zr------------------------------' Water Supply: Public system ❑ iCommun'ity system ❑ PrivateIR Depth to Water Table 7P__ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamAJ Clay Loam ❑ Clay [❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 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.) _ Septic Ta, kk: Distance/from nearest well__--Distance from foundation____! '______Material___________________ No. of 11/c --- Size---------------------=----------Liquid.depth----------------- "�` Capacity----------------------- 0 Disposal Field: iJ Distance from nearest w I---ie'd - _-__Distance from foundation---/_Q-----------Distance to nearest lot line---:S-_____-_-- ❑ Number of lines--------- --- ---�}--------------Length of each line-----�Zl---------ri-------.Width of trench,-'. "--------------------- ' Type of filter material -__________-Depth of filter material___.__� __________Totai length______Vie_'__________________________ rn Distance to nearest I -------Distance from foundation------ v_______.Distance to nearest lot line____ ___________' , tNumber of pits---.-)---------- ----Lining material----4'-_1 ------------Size; Diameter_L__X `� _X ---Depth--------------------------- Cesspool: �} j Disfarice from nearest well-----------------Distance from foundation--------------------Lining material____----________.__._______________f ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity-.-.------------------- ----gals Privy: I Distance from nearest well-------------------------------------------- ----Distance from nearest building________________---_----____--___.____. ❑ i Distance to nearest lot line------------------------------------------------------------------------------ ---- --------------------------------- -------------------- Remodeling and/or re ring (describe -__- --LA----��-- --- �`^ c--------- ------ ====v.,7.!1__ _____---___ _______________________-_-_____-___-_r___________________.----------------- ------------------------=�------------------------- �------------------------ -------------------------------------------------------------------------------------------------------------------------.------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statpp-laws rules and regulations of the San Joaquin Local Health District. Si ned fit/ ------------- (Owner and/or Contractor) { 9 )-�- 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 APPLICATION ACCEPTED BY-- I �ll�y�� .' ----- --------------- =----- ----------- DATE----- - ----------------------------------- REVIEWEDBY ------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommend ations------------------------ ---------------------------•----------------------------- ----------•- -------------•------------------------------------------------ I -------•-----------------------•------------------------------------------------------------------------------------------------------------------------------------- •-------------------------- '" . -------------------•--------------------------------------------------------------------------------------;-------------------------------------------------------------------------------------------"----------------------- FINAL INSPECTION BY-------------V4y1__N--L'V�-------------- Date- ------- "Y ------------- 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 ES-9--2M , Revises 1.57 F.P.CQ.