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APPLICATION FOR SANITATION PERMIT Permit No. __.`�.r....._._... (Complete in Duplicate) .� Date Issued ---- le ------�-- 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 . 549. JOB ADDRESS AND LOCATIO --?'yl-0--o ---------- -- --------- -------------------------------------------------- Owner's Name-------------%---- --------- ------------------------------------------ -- Phone.......................... Address-----------RYJA--•---- -------------------••-------------------------------------------------------------•----•-------- Contractor's Name-------------_----------- --- ----+ -- - - - ------------------------------------------------------------------------------ Phone................................... Installation will serve: Residence trApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms__ Number of bathsf_ _ Lot size 6� -------------- 0 Water Supply: Public system ElCommun'ity system [Private E] Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 12,11HI'ardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes M- No ❑ FHA/VA: Yes P"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_._ "------Distance- from foundation----/i-------Material +_ _-_. No. of compartments _._ _----_______Size__�___( -A---4(D--.Liquid de �t ---- Capacity_____ Disposal pfd: Distance from nearest well Distance from foundatio ------------------__Distance to nearest Igt line [ / Number of lines________ _ ______ ______ Length of each line-------7-4.�.............Width of trench_______i_�_>'_�#4 __________. Type of filter materiaL_ �1 �GDepth of filter material____� ��_ _ _Total length___ __ Q______ ___________ - i Seepage Pit: Distance to nearest nwell--___ "�--------Distance�o fou ation_____iZf___.Dista to nearest lot line Number of pits------1Z-----------Lining materia/. _ -_ _...Size: Diameter__91:----•.__•..Depth-----I"---------------- c� Cesspool: Distance from nearest well_________________Distance from foundation___._. _.____.Lining material------__ _.__-_____„_______. - ❑ Size: Diameter--------------------------------------Depth - --------------------------=-------------Liquid Capacity---- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building -- ❑ Distance to nearest lot line--- -------- ----- -------- -- ----- -------------------- ---- -- ,� -- Remodeling and/or repairing (describe): ` '�' �4�6i ------ ..................... ---� -•----- ------------------•-- --------- -------------------------•----------------------------------------------------------------------------------------------------------------•-------- -•-----------------_,. 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 ru s and regulations of the San Joaquin 4p Health Distelct. (Signed)---------------------1�_------------ ' ---------- ---- - ---- .- --------- ---- --------- --------------•------------( r Contractor) By: e - - - - -- ------------------------------------------(Title) �- - ----- -- (Plot plan, showing size of lot, location sys+em in relation to wells, buildings, etc., can be placed on reverse s ;, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - ---------------------------------------------------------------------- DATE -- -..--•---•-•-'--=-� REVIEWEDBY-------------------------------------- ----- -----------------•-------------__ DATE......................................................... BUILDINGPERMIT ISSUED......................................-------------------------------------•------ ------------ DATE_--------------------------------- -----•- ..------ Alterations and/or recommendations:---------•------------------------------------=----------•---------------•--- ........................................................•---•----••-•-•--- ------------------------------------------------ ----- ---- ----------------:---------------------------------------------------------------------------------------------- FINAL ------FINAL INSPECTION BY: ----------------------------••--- Date--------------------------------------------------------------7----........... 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 Revisea 1.57 F.P.CO.