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APPLICATION FOR SANITATION PERMIT Permit No. .. " ' O (Complete in Duplicate) /S� Date Issued __.._,_-'.91__ 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. r JOB ADDRESS AND LOCATION.. --------------�----G __ ----- . _ -- ---- 2�/ Owner's Name----- I50V.j_- --- t----- iYl------------•--------------------- --------- -------------------------------------------- Phone_. :-_7.3_ -Y Address----------- �p« :- Contractor's Name ' ----=---------- //JJ "2 -- -------------- Phone--- -------------- lam Installation will serve: Residence 5C_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--_ Number of bedrooms __ --_ Number of baths ---I--- Lot size -----7_S7 s_- ___________-__.-_ Water Supply: Public system ❑ Community system Z, Private ❑ Depth to Water Table _-`frCit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [I Hardpan ❑ , Previous Application Made: Yes ❑ No ;q New Construction: Yes [k 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 Tank: Distance from nearest well.•___Distance from foundation---IV__-------Material----- RL No. of compartments..-.___�. ------.-----Size----�__�4_�_X_ -------Liquid depth-------',�'�_�-----------Capacity--- ------ � Disposal Field: Distance from nearest well_4-ut-r-e----Distance from foundation--- 4-- -___-.Distance to nearest lot line.__S___--- Number of lines-_:-_____--__ g ------------------Length of each line------?c __._.�_�______.Width of trench---2.1`'�'________-.__.__ Type of filter mate ria l____%��.'A-_____Depth of filter material____.19-- ______.Total length-----l0-'0__-___.._________-_--- S e Pit: Distance to nearest well---a o"A'1_____ ?is�' Distance from foundation__________ Distance to nearest lot line- ------------- p� ❑ Number of pits_-____.'2,.------Lining material-----•''_r,_-t----Size: Diameter__jkX'_. . Depth-------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.____.Lining material-----------._--___________---___-__. ❑ Size: Diameter-----------------------------------Depth--------------------- --------------- - - - - - -----._Liquid Capacity-.-------------------------- Privy: Distance from nearest well_____________------------------------------------Distance from nearest building------..____..--___._-____.-._.__-.____._- ❑ Distance to nearest lot line----------------------------------------------- - Remodelin and/or e g / r r pairing (describe): -------•----------------------------------------------------------------------------------------------------- ----------•---------------------•---•------•----------•----•---------------------------•---------•-- --------------------------------------------------------I---------------------------------- ------------------ -------------------------------------------------------------------------------------------- --------------------------------------------------------•--------------------------------------------------------- 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 les and regulations of the San oaquin Local Health District. -- (� (Signed) �� - --- --- -------- 1iK------GO ----------- ------------------______________.(Owner and/or Contractor) BY: - - -- -------- ----------------------------- Title (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-______- __ _L_Yj[)U� -_._ : ________----_- ( 1 ------------------------------------ DATE---- / - ------ ---------------------------- REVIEWEDBY ------------------------------------------- ------------------------------------------ DATE= BUILDINGPERMIT ISSUED------------ -----------------------------------------------•--------------------------------------- DATE----- ----------------------------------------------- Alterations and/or recommendations----------- --------------------------------------- - - -------------------------------------------------;------------•-----------------------------------------------------------------------------------------------•----------------- ---•----•------------------------------- FINAL INSPECTION BY:-------- �r--- Date l_1-�_ �0 fSt' SAN JOAQUIN LOCAL HEALTH DISTRICT `1P30 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.RCO.