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APPLICATION FOR SANITATION PERMIT Permit No. ---� _ 7- (Complete in Duplicate) �C � Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the(woor13 3,0 k here described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------- � -- '- - r C�i / r ------- ' Owner's NameJUo-C.Y---- Phone— " Address----------•--•--- - ------ ----------•------------------------------------ Contractor's Name--------• ----- --------------- 4-y`-V�-�_�------------------------ Phone Installation will serve: Residence �partment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: ,J.-.--- Number of bedrooms -_ 'Number of baths /__. Lot size _--- - - Cf .- _ __ �___-_--___-___-__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe s and an ❑ Previous Application Made: Yes ❑ No slew Construction: Yes to 0 FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well-_. U__f-Distance from foundation--- f f_ _---._--- M�ffieriaI------ _f�r-- C_,L No. of compartments.-------_-0 --------Size-----�GLX-YD-------Liquid depth--- ice„--------Capacity--------oz----_---- Disposal Fi Distance from nearestwell...--�0_f7Distance from foundation-x -----------Distance to nearest lot line. _.�-_____ Number of fines-----------------------------------Length of each line---___-J---- --------------Width of french---a--`�--------........... . Type of filter material--- ro_c_ ----Depth of filter material__- --------Total length-------- Seepage Pi Distance to nearest well----�G_q.--_---_Distance from foundation--.../_u---_.-...Distance to nearest loft line--- ----c Number of pits------�--------------Lining material-->^-.-----r__-_- .Size: Diameter___-___ > -- �-3----- ----Depth-----�- ------------------- Cesspool: ------ - Distance from nearest well-----------------Distance from foundation-------------------.Lining material------....--------..- e El Size: Diameter----------------------- --------------Depth---------------------------------------------------Liquid Capacity-------------------- -----gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ El Distance to nearest lot line------------- ----------------------------------------------------------------- Remodeling and/or repairing (describe): - -= �f ----------- --------------------------------------------------------------•--------•---- •----------------------------------•---------•-----------•---••------------------------------ ----------------------------------------------------------------------------------------------------•-•-•--•------------------------------------------------------------------------------------------------- -------------- 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 r les d reguI do s .ofhe San J ur`n_;Local Health District r (Signed)--------------------i--- -• ----------------------- _ 'f'2- J -----(Owner and/or Contractor) BY� —u ----- -- ----- �j� -�� (�� --- ------------ )------ i �� -- --------- (Plot plan, showing a of lot, lo c' tion of system in relation to wells,.buildings, c., esn be-placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- —r-l-R-0--= --------------------- - ---------------------------------------- DATE------- REVIEWEDBY--------------------------------------------- ---------------------------------------- -------------------------------------- DATE------------------- ------------------------- BUILDING PERMIT ISSUED--------- — DATE- -------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------- - -----------------•-------------------------------...------------•-------- -------------------------------------------------------------------- -------------- -----------------------------------------------a------------- ---- ---- n---- - -------------------------- --------------------------1------------------- ---------------------------------------- ------ FINAL INSPECTIOt~t-- . - Date--------- SAN f a -- 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-7-2M , Revises 1.57 F.P.Co- i