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APPLICATION FOR SANITATION PERMITrmit No. ._l_��_4z it. D (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 LOC N.•. G?'- .5�'�`------- i f Owner's Name Lr --•---- - ------------- Phone Address---------------------------- - = --- - - -� - - ----------------- Contractor s Name_____________________________ Phone �r-' � -Q � Installation wil( serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other Number of living units: _[_ Number of bedrooms Z--Number of baths _/_-- Lot size ----:•--____-- 6W 11 = Water Supply: Public system j Community system ❑ Private E-] Depth to Water Table (e ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam p Clay ❑ Hardpan ❑; Previous Application Made: Yes ElNoAr New Construction: Yes El N0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sptic Trk:/ Distance from nearest well_________________Distance from foundation--------------------Material --___.__--____.-_-_______.________...______.__. No. of compartments----- -------------------Size--------•-----------------------Liquid depth---------- ---------------Capacity--_------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line__•____________-_ OjV��AW, Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material_____________/__________Depth of filter material-----------------------Total length___.____.______________._____________.___ Se age Pit: Distance to nearest well---- - ---- , ---Distance fr m foundation--- ..........Distanc -,to nearest lot line_--__----. rr _________Linin material_____ Size: Diameter____y Number of pits f g - '�,?.------..Depth-------2— ------ --- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material______._________-__._______._________ y� ❑ Size: Diameter------- -------------- - Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.__-.__________________________- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------•--------------•------------- Remodeling and/or repai g (d'escribe�:--- - -•-- � _ - .�---------------- Y� I t✓G �r �� .=_�--.r__.------moi ----- �----- -----------_��0_____� '� 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 reg ions of�fhJoaquin Local Health District. 47 (Signed)------------------------ -----••-------------- ------ --- -- ------ -- -------------------- --------- (Owner end/or Contractor) By------------------------------------------------------------------------ --------- - ---------------------(Title) � �-- (Plot plan, showing size of lot, location of system in relation to wells, b gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - --- DATE- '----------------------------------------------------- ----- ---- - --- - - --------------••-•- REVIEWEDBY ------------------------ ------ DATE_____f� •----------- ------------------------------------ BUILDINGPERMIT ISSUED----------- --------------------------------------------------------------------------------- DATE-------- ------------------------------------------------ Al ---- ----------- Al -a�fJians andor recommendations: - P!7 IS P?hF �j ---------`-------------------------•---------------- ---------------------------------•-------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ---------------------- ------------------------------------- ----------------- ---=- ---- -------------------------------------------------------------------------.-------------------------------------------- --- --------------------------------------- ---------� ------------------- -- L_� FINAL INSPECTION ..BY:-_ - -- �---------rte Date---- -- 3�-�- -------9- --- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California] Manteca, California Tracy, California E5 9-2M , Revised 1.57 F.P. ° �� 7