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�o 'It "yAPPLICATIONFOR SANITATION PERMIT . Permit No, __�� _�-_Ll F` �,t" j.-• (Complete in Duplicate)* ate Issued Application.ls'h'e by made to the San'Joa uin Local Health District for permit to construct and install the work herein de cribed. q p s This application is made in compliance with County Ordinance No. 549. . JOB ADDRESS AND CATION-. -- - -r------- -e----- - -- - -- Owner's Name a�`R.? 4.iL Phone / - -- ----------------------------------- ------------ Address-------------{----`-;rte/.. - --- Contractor's Name________________ ' Phone/ - =l�o_p-7 Installation will serve: . Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms *-3_ Number of baths J, Lot size -----3 Water Supply: Public system'❑ Community system Private F-1P Depth to Water Table y ft. I .. ._ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ *lay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes E] ,No _ New Construction:-Yes J No ❑ FHANA: Yes ❑ No ❑�� TYPE OF INSTALLATION AND SPECIE(CATIONS: }` y S .� .. ,E(No septic tank or`cesspool pe;mi#ted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest weft zix�---------Distance_fro��m//foundation____ )� P #i Z4 X!,3_�a_ ---Liquid`de0h-------Z----------------Capacity• --- No. of com artments_'_ __ _______ ______Size_____ Disposal ield: Distance from nearest we€!_.Distance from foundation___— ...._.....Distance to nearest lot line_____ ------ Number of lines---_--•- --------- Length of each line-___ 7_,S------------------Width of trench.___�-/_______-.._.___---- T e of filter material_ p Total length_______��-S`_�______________________ yp ,�-� -__ _ Depth filter materEal___��_________ Seepage it: Distance to nearest well__?4rt_V_P1----Distance om f'-undation___A;P?Q------.Distance to nearest lot line_________ ______ Number of pits----- �________;__'Lining material_. -: Size: Diameter:_--s3J...I______Depth-".aR_4"7_--__-__--__.____._ Cesspool: Distance from nearest'well_ =__�.---_=__,RDistance from foundation_______`_______.___.Lining material-------------------------- ---------- ateral____..___________________ __________ ❑ Size: Diameter----- =---- ------- ------------=Depth---------------- �` ".....'-----------Liquid Capacity-- •-------=- ---gals, Privy: Distance from nearest well_______________ _ _____________.___-___•:__..D stance from nearest building_._______.___._______--______k__._____. 4 ❑._ Distance to nearest'lot line:w __ -= -'. = A -'- ---•-- ------="- -- _ • Remodeling and/or ,repairing (descrii?e):-------------.----------- - ----= - ----------------------------------------------------------------- }.------------------------------------------------------ ----=-------•-----•---------------- --- -----------------------------•-------•------------------------ I hereby-certify that I have•-prepaied this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations_of the S n Joaqu', LocaljHealth District, _. (Signed) ,--------------&_ _ --- r.) (0 ner and/or Contractor) By:-------- - . r (Title) .. Plot Ian, showing size of lot 1. .• --•-- - --- -------- - )---------- _4-------------------------------------- w ( p g , location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY--------- -=--- ------ ----------- ---------J---------'--------------------------- DATE.------ - --REVIEWED BY �. ---------- ---------- ------------=---------------------- DATE---------------/--:Z.-q•• BUILDING PERMIT ISSUED-------------------------- -- ---- --------------------------- - •--------------------------•------------- DATE--------------------------• �-------------------'----------- 1 d Alteration��--- 2�ndat�ons: E--------+ �' =" ----- ; - �o 'k ' --- 1{ t -t-}- -f° r --�-------S ' ---------------------------------------------------------------------------------------=---!-------=-------------------------------------------- - - ------------------------------•------------------------------------------------------------------------------ --------------------------------------------------- --------------------------------------------- ----------- { f FINAL INSPECTION BY___________________ _� ---:- ------- Date------1: --------------- " 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 E5-9-2M . Revised 1.57 F.P,CO.