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� � v 7/v fl�✓' iLl'�/�-'� F l�wr � `�-�� , �J`f�FeL ,� .-_ ' APPLICATION FOR SANITATION PERMIT Permit N .._____ .._____. i' b (Complete in Duplicates g� Date Issued _--- --_- _- �Y AIplicafion 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. 11 d _ JOB ADDRESS AND L TION_______ ___ _ _ _ _ __*------- 4r . . �_ ,------------- __ ---------------------_------------------ Owner's Name--------- -C 1- _C�F__,V_j6 ER D-7 Address_..--------- - -----•--------------------------- - Contractor's Name--------------------- t.�_- _ — -- Phone_.-�T"f�- - __ ------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits:0M_ Number of bedrooms i; D Number of baths l 24, Lot size ___,_�Z?_-----X_- O -_----_------- Water Supply: Public system ❑ Community system ❑ Privafe �[` Depth to Water Table �37_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobeo Hardpan { j Previous Application Made: Yes ❑ No New Construction: Yes ❑ No j ! TYPE OF INSTALLATION AND SPECIFICATIONS: .r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------------Distance from foundation--------------------Material ______-_-_____._.______ -------- s ElNo. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity ,--- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_---_------___- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french------------------ ---_ 11 .i Type of filter material-------------------------Depth of filter material------------------ -Total length----------------------------------------- 14- Seepage Pit: Distance to nearest r well_ : l ____.____Distance from foundation .-..Distance to nearest lot line_________ 1.9 Number of pits-0,N19---------Lining material.r9_R_f�-I',--"Size: Diameter-_�s�____..____De th_ -0__-__.____ p -- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------_------------ ❑. ' Size: Diameter--------------------------------------Depth------------------------------------ ---------------Liquid Capacity--------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot lin - ------------------ g - -------••-----••-------------- ----------------------------- --- ------------------------------ Remodeling and/or repairing (describes:. _.: ' _ -------- --,--►-- -------------------•------------------------------- - ----------:_--------------------------------- -------------/J-----------------------------------------------------------------------------V ----- •-------------------------- --------- -----"-------------•------------------•----•---------•----_--------------------------------------------------------------_---------------... - �l hereby certify that 1 have prepared this application and that the work will be done in accordance with; San Joaquin County ordinances, St fe laws, and rules and regulations of the San Jo quin Local Health District. (Signed r -��.P V514-A-Al - h iYL ,rr------- ------(Owner and/or Contractorr By:_ ---------------------------------------- Title--------( r (Title)� - ------ ------ -• ----------------------- (Plot.plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be place on reverse side). .s i FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY___ -6--i _____ _______ DATE __-__ _ ------- -- ---- ------------------------------ ------- ----------------------- REVIEWED BY------------- DATE__.c _ `5 --- BUILDING PERMIT ISSUI=D �� L � ---------------------------------------------- -- DATE_---------- Al+erations and/or recommendations:------------------------- -------------------- --------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------- .r ------------ '-----•-`- -----------•------------------- ---- . - FINAL INSPECTION BY:-----------"-- X"------------- -- - 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 1 ES I9-2M 8-51 Revised W-2100 I€