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_ r APPLICATION FOR SANITATION PERMIT Permit No. ___0OI -_- ---------_ (Complete in Duplicate) b Date Issued __G__--_l--!_.---- �/l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549. JOBADDRESS AND --- ------------------------------------•----------------------•-•-------------- Owner's Name------ -=----•-�r7/+'" ------------ ------•--------------------------------- -------------------------------------------- Phone---------------- ------------------- Address------------_ Dr_�--- t --2 - - --- ------------------------ -------------------- ------------------------------------- ---------------------------------- • - - -- Contractor's Name------ - -------- - - --- ---- ------------------------------------------------- -- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .01 Number of living units: __/__ Number of bedrooms A- Number of baths ___f_ Lot size .�p-/rlQg?-------------------------------- i Water Supply: Public system UKCommunify system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No ( New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: Septic aokse tic tank or cesspool permitted if public sewer is available within 200 feet.) p , = ,c�/ Distance from nearest well 1J Distance from foundation._-_/P__.____-Mat.ri`'_._� --------------- -- ---------- No. _ ______ No. of compartments____ If__ uid de th____ __-� Ca aci ,S.Q___--- 9 p �-- p tY--�--•� pp Disposal Field: Distance from nearest welL '�Distance from foundation_-AO__ -------Distance to nearest lot line__-, �_ _____________ _Length of each line___ _ �� Number of {fines____/_____________ .." f �__� -- -----------Width of trench---- -- -17-�--- ---- ------- Type of filter material _ /r � Depth of filter material length_____. �____-___________________ a See�page Pit: Distance to nearest well------ Distance from oun tion____ c� �_�_.___.Distance to nearest lot line________________ 4, Number of pits-------_�________Lining material/l_/ -- . Size: Diameter—i? -----Depth th------�� Cesspool-. Distance from nearest well-----------------Distance from foundation--------------.___-.Lining material-------------------------------------- f_1 Size: Diameter------------------------ -------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________ -------------------Distance from nearest building------------------------------------------ ElDistance to nearest fot line. ---------------------------------------------------------- ------------------ ------------------------------- Remodeling and/or repairing (describe)------------- -------------------------------------------•---------------------•---_--------•-=------------------------------------------------------------------------ ------------------------------------------------------- --------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f (Signed) ----'!�/ -------- (� Contractor) By:------------ ------ 'E ----'--------------------------•----------------------------(Title)----cr��'yl (Plot plan, showing size to+, location of system in relation to wells, buildings, etc., can be placed on reverse s' e). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- --------- -------- ----------------------------------------------------- --------------------- DATE_ �-------------------------------------------- REVIEWEDBY---------------•----------------------------------- - -------- ------------------------------------------------------ DATE--------- ---------------------------------------- BUILDINGPERMIT ISSUED--------------------------------- ----------------------------------------------------------------._ DATE--------- ---------- - ------------------ ------------ i = Alterations and/or recommendations_____________ ___ ______ -- ------ --- ; :== -------------------------- ---- s :::.:.:.::::.:.::.... . : . ---. . = =r FINAL INSPECTION BY: Date.--- - r - ------------------------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ 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.