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APPLICATION FOR SANITATION PERMIT Permit No. __f-d_.--Z(1___ (Complete in Duplicate) i 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, r JOB ADDRESS AND LOCATION--- - --- --------- --------+- --- ��------ ,. ,. Owner's Name-----------•---- �� '7(�-9 Phone--------------- ----- Address r ! ----------- -------------- -- _---------------- - -- / --- --•-- ---------------------------------------- ------- ---Contractor's Name__-l_ (C __ Ph Phone Installationwill 1serve:. Residencet�t�ent House Commercial❑ Trailer Court ❑ Motel ElOther ❑ `Number of living units: "�. TNumber of bedrooms .-__L-Number of baths._._._ Lot.sizero-^._ WateriSu I • Publics stem �ommunit system Private Depth to Water Table Y � ""` i' PP Y� Y Y Y ❑ ❑ p �_ ft. Character of soil to aidepth of 3 feet: Sand ❑ revel ❑ Sandy Loam ❑ Clay Loam ❑y Clay ❑ Adobe ardpan I s r Previous Application Made: Yes ❑ Na New Construction: Yes ❑ No /VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan 'or;cesspool permitted if public sewer is available within 200 feet.) :., Septic Tarnk•1 1 ante from nearest well------_----------Distance from foundation__._.__1__________'.Material________________-___. ---------------- -------- No. of compartments Size------_-------------------_ Liquid r ,r• P - depth--------------------------Capacity----------------------- D _..-------•----------- Disposal Fie Distance'from nearest weft_______----------,Distance from foundation---------------------Distance to nearest lot line------------ N ___________.___. Number of lines_________________________________ Length of each line______________-______________.Width of trench_______________•__.____________--_, Type of Vter material_ - ----- eP -----------------------Total length------------------------------------------ Seepage -----------------------------------------See a e Distance'to nearest well___ from foundation___ ,0_-t_._.__..Distance to nearest lot line__/a_____.- Number of pits- -------------Lining material--- t2__ rA-"-.Size: Diameter------?�-_-----_.Depth__-- ..____._ t r � ------•--------•- Cesspool: Distance from nearest well----------------- from foundation-_ ______._.__-___.Lining material----_--------------------------------- ❑ Size: Diameter-------- ------------- ---------------Depth---------------------------------------------------Liquid Capacity...-------------------------gals. t Privy: Distance from nearest well__.______________ ______________.-----------Distance from nearest building______________.--__-_________-___,_ ❑ Distance to nearest lot line---=---- ----------------- = -- Remodeling;and/or_repairing {describe)___________ ---- •- ------------------------------ - ---------------------------- -------------------- -------------------------- ----,-------------------------------------------------------=------- - ----------------------•----------- ---------------------------------------•------------------------------------------------------------------------------------------------------------------I—-------------------------- I hereby certify that ! have prepared this application and,that the work will be done in accordance with San Joaquin County ordinances, State lawsfize-of and rules a re uc� Itit1ons of the San Joaquin Local Health`District. f (Signed)--------- °- � / -------------------- ------------------------------------- ----- �_ {Owner and/or Contractor) $Y: -- - -----lZ 2/i ✓L-� --- -- �- -------)Title]-- C ___(Plot plan;"showin , location of system in relation to wells, bui i etc., can be placed on reverse side] FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------------------------------------------------------------------------------------------ DATE REVIEWED BY------------------ ------ ---- ---'------- -- ----- -k ---- -----------------------------------------. DATE._BUILDING PERMIT ISSUED------------- - - j 1 • SS -------- ------ - --------------------------------------- DATE Alterations and/or recommendations----------------- ----- --- -- ---------- ------ ---- :__. ----- ti- -•--------- ------------------ ----•-•-•---------- ------------. ----------------- ---------------------------------------- -------------------------------------------=- ---------- i f ----------- - F FINAL INSPECTION BY..___ I � � ---- - -=----------•-- -_------- Date f � A _3 -------------------------------------- SAN - -------------- ---- ---•-••---SAN JOAQUIN LOCAL HEALTH DISTRICT i f30 South American Street 300 West Oak Street 132 Sycamore Street Y 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California k E5-9--2M . _(kms• Revised 1.57 F.P,CO.