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' S .k4 `I APPLICATION FOR SANITATION PERMIT Permit No. . Z_.�f ____ (Complete in Duplicate) Date issued :Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I � JOB ADDRESS AND LOCATION___ __ -fl-_-� -- - / f �Sf� � � =s�- � � -- ------°--------- Owner's Name--------- „ L+> L -----------------------=-------------------------------------------------- Phone-_--------------------------' L p------•------- Address--------- S / Contractor's Name = Z 4'�� -------------------------------------- --------------------------------------------- Phone----•-------------•--------•------- �' 9 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __: __ Nu berof bedrooms . -- Number of baths .__ _-- Lot size ------.�V_�__L23---------•--------------- Water Supply: Public system TCommunity system El Private [11 Depth to Water Tableft. x .i Character of soil to a depth of 3'feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ i No �_ r } TYPE OF INSTALLATION AND SPECIFICATIONS: :�y,Cy� i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r �r l Septic T Distance from nearest wel � t f /-4 -- � Distance rom foundation____ Material___ _ -a-fF_____ 4'--• ------Li Liquid de th-------- ------ ----Capacity--••-f--'�4----- No. of compartments---- --- -----------=---Size----�--�(•--- -- q p. - . / 1 Disposal Field- Distance from nearest well___ Distance from foundation___ ----------Distance to nearest lot I�ne__�__.______ ❑ Number of lines_______�1___ _!_-j __ Length of each line._____ !Q_�__________.Width of trench._____ ___ 3 w - at Z------- �° Type of filter material_/_��_f-ec..i_Depth of filter mate -------------- length____t�_.�0-------------------f--.- f Seepage Pit: Distance to,nearest well'__ _ ��'___- -Distan e from"foundation___ ___________Distance to nearest lot line ❑ Number of pits._..___..__._ .____Lining material _-__ j ��.Size: Diameter__.F _ ---------Depth_. _________--- ..J I�Z H Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material__.---.._-..__.___________._/- - ❑ Size: Diameter----------- -------------Depth------------------------------------------------- Liquid Capacity gals Privy: Distance fro':nearest well________________________________________________Distance from nearest building__.____________-________________'-___-_- ❑ Distance to nearest lot line--- ---- ---------------------- -'--------- ---------------------------------------------------------------------------------------------- t Remodeling and/or repairing (describe): -------------------------------------------------------------------------------------- ----------------------••------------------------------ -----• f ---- - -- -- -----------•--------------------------------------------------------------------- �. = --I.ii---�- __..� ------..1--------------------------------------------------------------------- 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. SE ned ----------------- --- - ----------------------- (Owner and/or Contractor] ----- ---------- (Title) ---------------- ------------------r - (Plat plan, s owing siz! f lot, location of system irMlation to wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _ ------- ---------------------------------------------------------- DATE------- -- --[-- ' --------------------------------- DATE----- REVIEWED BY------------- --- -------------- AT PERMIT ISSUED-------------- ------- -------------------------------------- DATE----- ----------------------•----------- ---------------------------------------------------- erati - -----omm 7� ns:----+�------------------------- ---- -------- ---------------- ------------------------------- rations and/or recommendations: = � �'-U- � f J� pl,A�- Ja=—D-- ----- _ f r1�a PAF.-o ' .J�1.t� , 'r _ Sr�ieFAC� F ----------------- ----------------- '" -------77.e•_ti" ------A/ /�7-0,1--/✓ �O 0/V,5. FINAL- INSPECT j[_ BY::----.—:------ - -y------"U,m, -- ----------- - Date--- ' ri'" S N J OCALHEALTH DISTRICT 13 SSouth Ameriean'S#rea# 300 West Oak Street 132 Sycamore Strss# $14 North " Stockton, California ,rte Lodi, California Manteca, California Tracy, California i ES-9--2M � Revised 1.57 F.P.CO. ""