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APPLICATION FOR SANITATION PERMIT Permit No. .!- _ _l._ . (Complete in Duplicate) S -_ 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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION le t }-- 0A.-A----- -------------------------------- Owner's ------------------ ------Owner's Name-----W___11----Z----'--�.D. ------_-------------- -------------------- ----------- ------------- Phone--------•----------------------•---- Address-----2,.!_-.....A--------- J9� --- —�y_� .>��L�� Contractor's Name----�-.(�zz ----- a------6 ,-_�- 0.7 �.�.- ---.Q-0-Dqu, � 1f i�fle�`t,-.---I__�_�_� _ Installation will serve: Residencepartm nt•House /Commercial ElTrailer Court E] Motel �❑ Other [j Number of living units: ------ TBer o e roo s ________ umer eaths ________ Lot size _'�. ?__I�Y�_�_�____\_____________________ ED Water Supply: Public system Community systst ❑ .✓' em Private' Dpth to Water Table Character of soil to a depth of 3 feet: Sand ❑ _Gravel ❑ Sandy Loam R!( Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No E] New Construction:_.,Yes 0` No E] FHA/VA: Yes1 ❑,--Nol❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is,available within 200 feet.) --i Septic Tank: f Distance from nearest well____-SV__ fowndation__'5__-_---._.Mat rjal_._--- .__. __ _________-__. No. of compartments. -__.____--size._ 5 9_______'Li uid depth _____________Ca Capacity_____ __ ?_..___ P 1 q p. p ty 1 1 Dispos Field: Distance from nearest well ,,Distance from foundation_ _�� . -----.Distance to nearest lot line_______..._. Number_of lines_._-_ i :� _ � .7-,.Length 'of each line________ i;?_._�_______.Width of trench-. __.e., ---------------------- Type _._. ..._ ._____.. Type of filter material ---Depth of filter material A-9-----------Total length------� ------------------------- I Seepage Pit: Distance to nearest well____.____----.__.._-_Distance from foundation....................Distance to nearest lot line__-_____------_ ❑ Number cf pits----------------------Lining material-------------.---------Size: Diameter------------------____.Depth____________________--.__---___ Cesspool: Distance from nearest well-------------- from foundation-------------------.Lining material-__________________________._____-__ ❑. Size: Diameter------------------------- ------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well------------------------------------------------Distance from `nearest building_________._-_--__-_______.___.___.___._- ❑ Distance to nearest 1t lin ------------------------------------------------------------------------- ----------------------------- - Q. Remod ling and/or epairing (describe):___-- _=-WA - CQ_®-------------------aZ.q f -- -- --- ----- -- -��—�..n. ---------- ---- -` ---- ---------------------------------------------------------------------------------------------------------------------------------------- ------------•--------------------------------------------------- 1 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 Joaquin Local Health District. (Signed)-.--- �.��- . _---------------------------------------------- ------------------------------t----(Owner and Contract r) By:----- .:- ---- ----------------------- - --- --- ------- -_------------------------------- ---(Title)--- --- ----- ------- Y (Plot plan, showi g 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._.. - _1 � BUILDING PERMIT ISSUED---------- -`---- --- -- ---- ------------------------------------------------ ------ DATE--------------------------------I Alterations -- ---------------------- Alterations and/or recommendations-------- ------ ------------------- -------------------- ' , -------------------------------------------------------------------------------------_ ----- ------- -- -- -----------------)--------------------------------------------------------- - -------------------------------------------------------------- iwti .. ---------------------------------_-__ ____ ------------------------------.------------------ - .'' .-_-____. ._.--------------- --------------------------------------------- __---.-. ,______________ _ __----__.- ._ .. . _. __ _ ._____._- ______.___.___.._. .___. ._ _ - 7/ -4 FINAL INSPECTION BY:--- ------ -------- --- - Date - F,�!`� - ---------- f "". SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California l ES-9-2M Revisea 1.57 F.P.CO.