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C0�t A APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) J Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and in� This application is made in compliance with County Orlel the work herein described. dinance No. 549, J0 ADDRESS AND LOCATION-- ,cfV t - O �-i/y�c;Y,r.�,,, F w ,� ---- ----------- - -----------Owners Name-----�--•--�.�----��i�Y�\ . n ++ �4 = ----------------- Ph �l Address }-=4 17 s / i.1 ones]1 - ------ �- --•------, 1�- w� S- - r r Contractors Name--------------- � 1``=rte ------------------------------------ ------------ ----------------------------------------------- Phone Installation will serve: Residence Q p ' artment House ❑• Commercial El Trailer Court ❑ Motel ❑ Other Number of living units: - e D Y- ❑ T/----- Number of bedroomsNumber of baths /------ Lot size _:�-11--k----_.�-_ .__ Wafer Supply: Publics stem ------------ - y ❑ Community system ❑ Private ❑N, Depth-to Water Table -_----_ ft. Character of soil to a depth of 3 feet: Sand ❑ Grav_el ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 H rdpan ❑ Previous Application Made: Yes ❑ ,No [JfNew Construction: Yes o [❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest weli__� C1 r y Distance from foundation---/C ---___---__.Material__-`KC-$_ ( 1a IJ No,,of compartments---_-ice-_-:-__--__----r,Size--- - Liquid depth ...... --------Capacity------ ------- r Disposal Field: Distance from nearest well.:-_---_Distance from foundstion.--t-r-f--_--- -Width of trenchDistance to nearest lot Zine-__- -'_------ ❑ Number of lines----------j---------------- -=:Length of each ` 34 - . iline----__1�(?---- -------- --2:�- _ x Type of filter material__--- --------Depth of filter material---_.*_ ----_ --------Total length-------iu3----------------------------- _ ---- Seepage Pit: . Distance to nearest well_____________ "Distance from foundation______-_---______ Distance to nearest lot line-m .--_--_ ❑ Number of pits----------------------Lining aterial----I/-----�---------.Size: Diameter------------- ---------Depth---------- ------- Cesspool: Distance from nearest well--------------- Distance from foundation___-_---_----__-_-.Lining - - + - � """ --------- ------ Size: Diameter------------------------- --------- Depth:.------�-------------------------------------------Liquid Capacity--- gals. Priv 'f Y: Distance from nearest well---------------_----------------------------- ----------- Distance from nearest building ❑ Distance to nearest lot line___________ ------------------------------------------- Remodeling and/or repairing (describe):-------r }aV--__---1 (,9 ------------------------- ------------ ---- -------------------- ---•-------------•------------------------------------•--------------------------------------------1-•-------------•-----------------------------------------------------'--'-- ---- ------------"---.------__ --__---_-----__--____--_--_____-_�''_-_____- - ------I --------------------------`---------------------- ---------------------------------- I __---"- ---___- ---_ �_ 1 hereb cera y at havere"ared this ,pplication'snd that the work will be done in accordance with San Joaquin County ordinances, Sfato l UGs, a4 ry� a d regulat'ons of the San Joaquin Local Health District. I ,V" A/V {Signed)- =/ �` --------- ---------- ------------(Owner and/or,Contractor) BY-----------------------—•------------------------ k ------------------------------------------ 4 Title ------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_----- ------------------------- = � --------------------- DATE--------;^ � J ? ---------------REVIEWED / - ----------------------------------------------------------- DATE----- IL�D�I-N----G---'P--E-R--WCIT / - ` --------------h--- --- --- ---------aa -------------- DATE and/or recommendations:--- ------------------------------- ------------------------------------ ----------------- ..: . - ------------------------------------------ --------------------------------- ---------------- -- - ---- ------------ -- -- -- r -- ------------ ------ - -- --- -- - --- -- ------ ------ - B � r TIO ------- ------------ ------------------------ -'- ate-- ----------- ---------- ------ ---- ---------- --------=- ------- •------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree} E 300 West Oak Street 132 Sycamore Street 814 North "C" itreet 1 Stockton, California Lodi, California ' Manteca, California Tracy, California ES-9-2M , Rovised 1.57 F-P.CO.