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APPLICATION FOR SANITATION PERMIT Permit No. _. (Complete in Duplicate) Date Issued ----- .//r. i 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. x . / `r JOB ADDRESS AND LOC TIONO_f--. - -� t. .y,,...,, -- -- ( -- --------- -Owner's Name----------- = Y = ---- Phone------------ t lf� _ Address i ... l-�"--------r--�--------------------- 1 ContractorsName----- ------------------------ -------------------------------------- -------------•------------------- ---=-- Phone-------.--------------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [:1. Other ❑ Number of living units: .. --- Number of bedrooms .S--- Number of baths Lot size ---- -- --- �6 X- J Water Supply:, Publics stem Community system" p - Y ❑ y y - ❑`"Frivate`�De th Water Viable ._ _.... ft. a Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ,Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes UR"'I FHA/VA: Yes ❑ No ❑ 5 � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) _ , ` �_Sibpti-E`Tank: F Distancefrotn neare st=well `f '� Distant from foundati nIlI-._:_.-:.Material �f'�� ® No..of compartments �-___ ----..-Size',e),r'� -x_.. __Li' uid depth-...._. --------------Capacity_..._--_ Disposal Field: Distance from neare�stt�w�ell./��_--._.Distance from foundation_-.!!-_' -- ----.Distance to nearest lot line.-----5 ._..... Number of lines..''r 1.+o---_. .._--.---Length of each line-----��f0._°---------Width of trench----- — Type of filter material-__.:X. . `° --------------- yp -± .Depfih of filter matenal___ j ___ ---.Total length Seepage Pit: Distance to nearest well-------- --------Distance from foundation...................Disfiance to nearest lot line---.._..-_...._.- r ❑ Number of pits--------------- -----Lining material----------------------- Diameter-----------------------Depth--------------------•----------,• Cesspool: Y Distancesfrom,nearest}well.................Distance from foundation--------------------Lining material_.....__-----....__.___---------- ❑ Size: Diameter '_.`__.... Depth----------------"--------------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well----------------------------------------------___Distance from tnearest-building,_._ _----_........__._._..._ ----- ❑ Distance to nearest lot line--------------_____ - - -:- � . • _ .... ------"------------- -------------------------- ---------------- Remodeling and/or repairing (describe):-------------------- --------- --------------•---------•--------------------------1----------------- ------------------------------------- •--- --------------•------------•--------------------------------------------------------- I.._ €i -------------- ------------------------------- ------- ---- - 1. I hereby certify that I have re aced this a lication and that the T ------ ------------------------------ - -------- :4----------------------------•---------------•-----------•---------- Y Y P P PP work will doneJn accordance with.San Joaquin County � ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � 1 -- ------ - ' .Y - - ---------(Owner and/or Contractor) (Signed)----.--- "'�'��----------- --------------- -�------------- -------------------�--- tor) By:----- -------------- ------------------------ ------------ ---------- ----------- - -------------------------------(Title]---•--- --------- -------------------------------- {{ (Plot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be.placed on reverse side). `f l I – r --` FOR DEPARTMENT USE-C}NL Al APPLICATION ACCEPTED $Y � = DATE -5 �/ REVIEWED BY ----------------------------------- ------------------------- DATE------•----------------------- _.. BUILDING PERMIT ISSUED___.Y-------------------------------------- -----------6--------------------------------------------- DATE Alterations and/or recommendations:--------=---------------------------------- McCleary-dident know--he-__neede_d a ermit - had line du twice as inucri as needed P------- ---- - - - --- -----( -- -- - ------------ --------- - -- ------- s:Q - -----it---go - L•R ._.. tf)-- ---------- -- ---------- ------------------- ---- ----- ------------- - FINAL INSPI CTION $Y:.:-_ �, � �f '� - ------------- 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 � E5 9-2M ;ReviSeC°S':-5T•F.P.CO. �( -- - 4 __ 1 •. _ - A. K.