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APPLICATION FOR SANITATION PERMIT Permit No. a..z.7_L�... . (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 Coun Ordinance No. 549. - JOB ADDRESS AND LOCATIONst Owner's Name -Yz yw%...... .....------------------ --------------------- Address --- -------- -Address .?a ..... ----------•--•.................... Contractor's Name-------- . ....................... ----- -------------------------------------------............................... Phone.................................. Installation will serve: Residence YL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ...I..._ Number of bedrooms .Z..._ Number of baths ...f__- Lot size :• `_.._k. 1 .4........................ Water. Supply: Publicsystem M, Community'system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe t, Hardpan.❑ Previous Application Made: Yes ❑ No IR New Construction: Yes C& No ❑ FHA/VA: Yes ❑ No t& TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) t i Septic Tank: Distance from nearest well---Amz.ARI Distance' from foundation--._.i 0.1.'_.'.....Material_.t_LQ.A.LU( -d---------------- ...... No. of compartments--------- -------------Size----3". q_' .'.-Liquid depth__.....................Capacity... ��._ .- Disposal Field: Distance from nearest well_--VIQ-KP—..Distance from foundation... - 2------_-Distance to nearest lot line,.....!...... [ Number of lines........."�? -. Length of each line___. 4Qt-_ .Width of trench Z4........ . Type of filter material..3-s_-- �K-.-Depth of filter material--- "__.....:-Total length.._. 1 ? ........ .. ........ Seepage Pit: Distance to nearest well-:------._ -__-�_-.bistance from "foi tdation,;---------------...Distance to nearest lot line................. �} ❑ Number of pits----------------------Lining material:.` ------------------Sizer Diameter. ••-=--...-•----..Depth............................. - --- •--•--...:. ,Cesspool: Distance from nearest welt..... _..-_--Distance from foundation__:_.- .----------Lining material ---....._ ..._..:. .......... (� ❑ Size: Diameter. ---------- -- --- ---IIep-th-----------------------------------------------....Liquid Capacity.......... ----- .......gals. I Privy: Distance from nearest well---------- - ---- -_- --_--Distance from nearest building--------------------........-------------- Distance ......... ❑ Distance to nearest lot Line----------------------------- --------------------------------------- Remodeling --- -•-•-------------•-Remodeling and/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, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---�/-•- k.; P��?. .....okl--- 4d (Owner and/or Contractor) B t (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 APVLICATION ACCEPTED BY-----L'-ti-- --------------------- •--•-•-•••-•---•--•-- -----• DATE.- - -•-- --••-- •------- REVIEWEDBY.------ •--•----------- ------:--_ ------------------ --------- -------- -------- ------------ DATE............................................................. BUILDINGPERMIT ISSUED................................................. --- ...••-- ..........-•;................ DATE........-.............. ----- •... ........ Alterations and/or recommendations:-------------- ---------------------_--- •-- --................................................................................................. FINAL INSPECTION BY:.--C--t---- ----- --------•----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 , Revised 1.57 F.P.CO.