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iC ✓ • ti11� // ry \ (� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- r-I? Q� r------. ----- r7"�".`--------------- , Owner's Name-------------- •� ------------------ ---------------- Phone- - Address i ----------------------- - ------ ------- - ----------- f Contractor's Name -- -} •`'�" Phone Installation will serve: Residence Ant House Commercial Trailer Court Motel ❑ Other ❑ p ❑ ❑ ❑ Number of living units: _1_____ Number of bedrooms -o&-- Number of baths ---!-- Lot size ___-__._12)_ ------------------- Water Supply: Public system JK Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel E] Sandy Loam F] Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes El No a New Construction: Yes ❑ No K_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION. AND SPECIFICATIONS: AR (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) iciTo Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- `k No. of compartments--------- ---------- -----Size--------------------------------Liquid depth-------------- -----------Capacity------- ----------------------- ,`1� Oka iald: Distance from nearest well._f`LML_.._Distance from foundation_1—t_0_____Distance to nearest lot Cine... ...�J..P...... Number of lines_._--I------ _.___ _ Length of each -------------Width of trench.___�_$1.__'_!______________ Type of filter material_ er.. --_Depth of filter material_ $__/ --�______Total length_..-____-3Z"-_ 4P - --------------------- 4 � r01 Seepage Pit: Distance to nearest well 4it�e_________Distancerom foundation_`-�_�______.Distance to nearest lot line_________________ Number of pits.----t---------------Lining material__ _ O /.C�-------Size: Diameter____3,5 b*-______.Depth..._..Z.S-------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----._---------_------ ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------ _--_-------------_Distance from nearest building___-_-_-._--_--__--_-_-_-___-____.____. ❑ Distance to nearest lot line--- ---------------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)-------- f .0_.. G'6'A_ -�-------------------------------------------- ----------------------------------------------- -------------� ----------------.-------- ----------------------- 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 cal Health District. e � (Signed) __. Contractor Wy----------------4----------------------------------------------------------- - - -- - ----- -- -- ------------------(Tit le)-------------------------------------------- - (Plot plan, showing size of lot, location of system in anon to wells, build' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-P>--- ----------------- ------------------- --------------------------------------------- DATE-- --------------------- -------------------------------- REVIEWED BY-------------------------------- �._.,�_------------------------------------------------------------------------------------ DATE--r -- BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE____ ----------------------------------------------------------------------- .Lmr Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------- -------------•------------•---------------------- --------------------------------------+------•------------------ i ----------------------•-----_- ---------- ------- -------- ---------------------------------- - ----------------------------------------------------------------------------------------------------------------- -� �- -�---------�._.�---------------- --- --------------------------------------- -- ----------- ------- ----------------------------------------------------------------------.--- -------------------------------------------------------------- - �7 FINAL INSPECTION BY:.---- Date------ --- ---- --- -- ----------------------------------------------- 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 ES-9-2M , Revisea 1.57 F.P.CO.