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' �71 - �( APPLICATION FOR SANITATION PERMIT Permit No. ��(' (Complete in Duplicate 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 applicatibri is made in compliance with County Ordina No. 549. A JOB ADDRESS AND LOCATION_ __ _ .- ----------------------------------- ------- Owner's Name a ---------- ------ ---------- ------ Phone.-W -•7`� Address---------- ------------------------------• `J -----•-------------------------------- ----------------•------------------------ iContractor's Name--------------------- -----------------•----------- - -------------_.--- Phone------------------------ C)_711.- ---------------------------------------------------- ---------- Installation will serve: Residence r�A Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other 171 Number of living units: _ .____ Number of bedrooms --- Number of baths _/___ Lot size ______.____ l d Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -------- ft. )—,Z-Previous Character of soil to a depth of 3 fee-f: Sand E] Gravel E] Sandy Loam ElClay Loam ElClay ❑ Adobe Et— ardpan ❑ Application Made: Yes No Q New Construction: YesZ No ❑ FOIA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: ok f43S-- (No septic tank or'cesspool permitted if public Viewer is available wit sn20 ee:) Septic Tank: Distance from nearest well-- 0 01'_�Distance from foundation__fQ-_____-__.Material _____i ___ ________No. of compartments------ -- ----- SizeK �� --Liquid depth-----------�- apacity__--_-_ _CLQ-_-- Disposai Field: Distance from nearest well- .______-Distance from foundation---___jDistance to nearest lot line----- Number of lines____________, .___ � n Length of each line------------- ------------Width of trench._______4�.__ _______--__-- ' Type of filter material__,�___.�__,�y__�_ "�Bepth of filter material__._____lS___.__.To#al length______________- -.1646 �------------- " G - --- Seepage Pit: Distance to nearest-well----------------------Distance from foundation--------------__.-_.Distance to nearest lot line-------------- ` ❑ Number of pits-- -------------------Lining material --------------------.Size: Diameter-----------------------.Depth------------------------------ - *'� Cesspool: Distance from nearest well-----------------Distance from foundation___----------------.Lining material_-______________._.__.____-_________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------_____---------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line--------------------- --- --------------------- -------------•------- Remodeling and/or repairing describe):- --------------- ----------------------------- "� - --------- -- ---------------- ------ ---- ------------------------------------- > l-- -� f / ' ----'C - ------------------------- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 rules and regulations of the San Joaquin Local Health District. (Signed ----�z• -��___--�--- --- --------- �-- --- -------------------- -- -------------------- ------------------------ ---------------(Owner and/or Contractor) �..� Y�------------------------------------------------- --- ---------------------------------- -----------------------------------------(Title)--------------------------------------- --- - ------------------ (Plot plan, showing size of lot, locatio system in.relation to wells, buildings, etc., can be placed on reverse side). r d FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY-------- --------------------------------------------------------- DATE----------- ---- - ------- ------ REVIEWED 'BY----------- DATE - ---- ---------- --------=------- BUILDING PERMIT ISSUEDU ------------------------------------------------- DATE --Alterations and/or recommendations--------------------------------------------------------= - ---•------------------------------------------------•---------- -------------------------------------------------------------- -------•-------------------------------•---------- --------------------------------------------------------------------- r ---------------------- ----------------------------------------------- ----------------------------------- F1 NA L --------------------FINAL INSPECTION BY:--- = --------------- Date------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F,P.CO.