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,o- APPLICATION FOR SANITATION PERMIT Permit No. ._ -�-7l-.. . � (Complete in Duplicate) / Date Issued yl 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. .2,'$ 2'7 ------ i JOB ADDRESS AND OCA N ---------- ------ �� - - -- Phone--------------- ------ Owner's Name-------` f ---•---- --------------------- Address------------- -------Address------------- ------ Man-4 ..-------! ---------- - ------------ - ----------------------------------------•-------- Contractor's Named -fir .._ '(i" t;a---------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/__ Number of bedrooms .- umber of,baths ___/___ Lot size -____hC x 1_ / _______._________________ Water Supply: Public system Vk Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4 Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___.1�--'-#f�Distance from foundation___ __--___--.Materia4____ --- _ �—�___________________ No. of compartments______ _________ ____Size---•.-; . . . :__.Liquid depth------I r----.--------Capacity.-- _04 _.�._� Disposal Field: Distance from nearest wellil.6tt-e-_-Distance from foundation_/�_�________.Distance to nearest lot ine__J___/____. Number of lines.-__-------s�..-----------------Length of each line____��"' ---:-_---_.Width of trench____2_ ___ t k I Type of filter materiaL___17D.0 f_:-----Depth of filter material___. __'2t--____----._Total length______ ____________________________ s4i r S t: Distance to nearest well---n.'e,��.______Distance from foundation—*------ Distance to nearest lot line_____________.._ INumber of pits.-_.1---------------Lining material_?_i:_c'' _______.Size: Diameter__Yk_c.`-____-Depth___0/__._'-------_______-_-___ Cesspool: Distance from nearest wek€-----------------Distance from foundation--------------------Lining material___.______._--_----------------______- (] Size: Diameter--------------------------------------Depth....................... ------------------------Liquid Capacity----------------------------gals. \ Privy: Distance from nearest well________________________._.__________--___-__---Distance from nearest building----------------------------------------- F1 _________.___._________________--------❑ Distance to nearest lot line----------------------- --------------------------------- ----------------------------•---------------------------------------- a , Remodeling and/or repairing (describe)---------- ------------------------------------------------------------------------------------- ------------------------------------------------------- ------------- ---------------------------------------------•--•---------------------------------------------------------------------------------------------------------------------------------------------- ---- -----------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------- --------------------------------------------------•--•----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, an ,•rules and regulations of,the San Joaquin Local Health District. �f l u I-G✓N`/F .GJ�(r"� (Signed) C'e----------------------------------------------------------------------(Owner and/or Contractor) Sy:------------------- \u ��/--------------------------------------------------------------------------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- C ----------------------------------- --------------------------------------- DATE----------- j�-------------------- REVIEWEDBY------------------------------------------ - ------ ------------------------ ------------------------------- ---------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------------------ -------------------•-------------------------------- ----------•---------------------------------•-•--------------------•------- `/-9`s Y o/rc/45sj' --ARS ----- g �cs_-------`r R.P_r------------ ------------ ------------- . .. -` `AA -----------t-- ------04-----------------------------------------------------------------------------------------------------------------------------j _._ _KG -----•-------------------------------------------------------------------------------- ----- ----- --------------------------------------------------------------------------------------------------------------- ------------------- - --------------------- ------- • ---- ----------------------- FINAL INSPECTION BY: 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 ES-9-21x1 , Revised 1.57 F-?.CO.