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L� APPLICATION FOR SANITATION PERMIT Permit No. (Co lleyt�y�in Duplicate) f I - �/r/c�J✓d d c� �� e� Date Issued• -----��/��-- i l App icas hereby ma�e to a an J�oa uin Local H h District fora e 1 Joaquin p rmit to construct and install the work. herein described. This applicatio 's^ ayd}�ein pliance with Co my Ordinance No. 549. fkrrf I f JOB ADDRE . AND L CATION._ .�L __� - i Owner's Name------ - --- ---- ----------------------- ---- Phone ---- ------ - --- ----- ----------- --- ----------------------------------- ---�---•--•------=------ ------- -----. -- Contractor's Name----- - r. Irz -----------------•------- Phone_.................... 4 Installation will serve: Residence ®Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _/__ Number of bedrooms ._ Number of baths __ __ �__ Lot size ___ � �,�'�•.---_- i 1 Water Supply; Public system ❑ Community systemPrivate'❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel Ej Sandy Loam ❑ Clay Loam ❑ .Clay ❑ Adobe Hardpan ❑ Previous-Application Made:,Yes ❑ No R�' New Construction: Yes E'n( o ❑;, FHA/VA: Yesk�o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) v Septic. Tank: Distanceqrom nearest lel__ +'Distance from foundation__ _.Matgrial___ _ No. of compartments----- --------------- _ ----- --- - �-� - _� ----Liquid.depth -$`-'-�=--- ---------Capacity--��—e------ Disposal -_ __ z Disposal Field: Distance from nearest ' ell-1�Distance from foundation_--- _ r ..Distance to nearest Pir e__.e Number of lines_____ _ ength of each.lineynl -� // ��--.Width of trench Type of filter material_/) _ ,Depth of filter material-__° - Total length_______- �` _ ,, -------------------------- Seepage Pit: Distance to nearest well ______Distance-from-foun tion__'_�_�_*____ .�"'� _..__.D• t ;e to nearest lot line` Number of pits__-__-/__ g a__Linin materil_`-" ., - ¢e: Diameter_ ____._-_Depth__.. ___.__ ------ ❑ Size: Diameter:_-_-________.__ Distance from foundation__________________Lining material____._____________________-__-__-.. i p - Depth = - Liquid Capacity- -------------------------gals. ass oo : Distance from nearest well Privy: Distance from nearest well------- .. _ ---------------------Distance from nearest building__ ❑ Distance to nearest lot line. :_--------- �- ~`" ----------- --------------- Remodeling and repairing (describe):_____ ._._- ------------- -------•---------•-------••-----------------------------------------=------ ----------------=------------------------------------------------r ----------------------------------------------------------- --•-------------- ----------------------•--------------------------------------------------------------------------------------•----------------------------•• •----------------------------•------ 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. .R 9 (Signed)-- - -/ ! -- --- --- ---(0W=.=ra:�aV4r_Contractor) By: y ': F (Title) _ - -�------------- (Plot plan, showing size of lot, locate n of s stem in relation to wells, buildings, etc., can be placed on reverse ide). FOR DEPARTMENT USE ONLY APPLICAN ACCEPTED BY---------- DATE-------"----------- TIC` -------------•----------------------- REVIEWED BY----------------------------------------------------------------------------- ----------- ---------------------------------- DATE-.----------d-- BUILDING PERMIT ISSUED ------------------------------------------------------_ DATE------- ------- ----------------------------- ndations: ' '^ ------------ ------•------- -----I- ----------- -- --•- -----•-----•---•---------- and/or recommendations: f ----------------------------------------- Wa -----C�- k------------------------------- - ------ ---------------------- --------------------------------------------------------------------•-------- --------------------------------------- FINAL INSPECTION BY:--- --------= ------------------------ _. - Date------7"-----1 r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak:Sfieet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.