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#� fps .� APPLICATION FOR SANITATION PERMIT Permit No. ___ (Complete in Duplicate) �7 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. 1� ' _Z; f 30 ---�--------------- -------------------- --- ------------- ---- JOB ADDRESS AND CATION------ -- --------�------1--- --•------------------ --------- --- •- - •--- y ��``�� -------------------------- ------------ Phone---- Owner's Name.-----J-1 J.J-' h --------------------------------- 1 Address----------••------------------et.,- -------I-3-9-�`-'------ ---(-J--------------------------------------------------------------------------------------------------------•------------ Contractor`s Name------------------- j ------------- Phone--- -} rc.. l r. i; 1.1•ua�S �• 4C1� �-�o a.r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.__L Number of bedrooms __°"Number of.baths _-__J-_ Lot size -2--t2-0...... --------------------------- Water Supply: Public system E] Community system ❑ Private pth to Water Table ( _ ft. Character of soil to a depth of 3 feet Sa�g�ewConsfrucfion: vel F1 Sandy Loam ❑ Clay Loam [:1 Clay E] Adobe ©� Hardpan F-1Previous Application Made: Yes E] No Yes A/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 0 v (No septic tank or'cesspool permitted if public sewer is available,within 200 feet.) f Septic Ta Distance from nearest well_---------- Distance from foundation____ _(____.__.Material_� s_3 -C__ __________________ No. of compartments--------.�------------size------ r _ --zl-_Q----Liquid depth--- - -------------Capacity-_:47------ ' r f Disposal F Id: Distance from nearest well__,�Q_--/----Distance from foundation-___6Q______-_--Distance to nearest lot line_,:��._-_____-t� Number of lines___ __________________________Length of each line---------5 Q y Width of trench--- _................ _ Type of filter material---i--_c-c. --------Depth of filter material___AA_. ---.---Total length----------_�-Q__1------------------- See pa it: Distance to nearest well._.,! a-_-- Distance from foundation_________-..Dis#ante to nearest lot line---,.r --------- Number of pits._..__I______________Lining material__xr5!-S__�__.-.Size: Diameter- _ _-_-__.___-Depth--- ,e ------------------- 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------------------------------------------ F-1 Distance to nearest lot line-------------------------- -------------------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe}_____________________ ________R�51 -e, .______•___ _ _. ---------------------------------------------------I-----------------------• --------:----------------------------- 7 - .� ��---------------------------------- ------------------------------------------------------------------------------------------------------------•--------------------------------------------------------=------------------------------------------------------ --------------------------------------------------------------------------------•----------------------- -------------------------------------------------------------------------------------------------------------------- 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 mules and regulations of the San Joaquin Local Health District. (Signed)-- _-__1�®_7-_ 6 -S? J G�� --------------------Owner and/or Contractor By:--------------------------------- - lam d ------(Title)-:----- - ------------ --------------- (Plot plan,showing size of ocatio of system in relation to wells, buildings, etc., can be placed on reverse si e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.- -e- -- DATE----J0-`I -----—-------------- --------- ------------- REVIEWEDBY------------------------ --------------------------------------------------------------------------------•-------------- ----. DATE---------------------------- BUILDINGPERMIT ISSUED---•-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alferafions and/or recommendations:------------------------------- -------------------------•----------------------------------- ....... --------------------------------------- ---=-------------------------------•-----•------------------------------------------------------------------------------------------------------------•---------------•---•--------------------------------------------------- FINAL INSPEC BY- --------- ----<---U19VDate-------- y� �*�� ........................................ 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-9-2M Revised 1.57 F-P.CO.