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APPLICATION FOR SANITATION PERMIT Permit No. �____ �`. AK (Completein Duplicate) Date Issued 1"�/Vf� 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. JOB ADDRESS AND LOCATION____-" -2-2-1-Y----A.-Y'e-, - ------------------------ ---Owner s Name----••--- --..L=" fl----•-•-- -----=£r-r--•----- ---------- -------------------------------------- �} p' ------------ ------ Phone . "d.lC3." Address---------------- ----------------- �_..7 -- ------------ ---------- - ---- Contractor's Name ------------•-•------ "-�z t 7 - --- --------- ----- ----� --- Phone.,/4___- ----- ----- Installation will serve: Residence impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: j--- Number of bedrooms ._ Number of baths 1.--- Lot size _-f -----1-d�- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table) ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Adobe Y ❑ Y ❑ Y ❑ Hardpan ❑ Previous Application Made: Yes ❑ No �New Construction: Yes No ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i9 1 _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .w Distance from nearest well-----------------Distance from foundation-----" / -"----------,Material ---- ----- --- ----------------------------- No. of compartments--------------------------Size------=-------------- ----Liquid depth---------------- ---------Capacity ------ osa`FW, Distance from nearest weiLAVTEL"_Distance from foundation_""__" -+ -_ ".Distance to nearest lot li a- Number of lines___-�"'- Length of each line__-�_ Width of french...ype of filter material" "-" -- ----- - -- Depth of filter material"-- """_Total. length""""_" Seepage Pit: Distance to nearest waif f1K "_--"Distant O undation"_ --___".Distance to nearest lot line_sa7""""�-"_ Number of pits-- f f-------------Lining material----Size: Diameter c�....... Depth o �-s Cesspool: Distance from nearest well--------___-----Distance from foundation---_-__" Lining material ❑ --------------------------------- Size: Diameter- e5f we - ------Depth--------------------------- --- -------Liquid Capacity---------------------------- gals. �j Privy: Distance from nearest well""- _Distance from nearest buildin El Distance fo nearest lot line - buildirg---------------------------- --------- Remodeling and/or repairing (describe)------------------------------------__ -------------------------------------------------------------------------------------------------------- ------•------------------------------•-- ere y rtify that i have prepared this ap ' ation and that a work will be done in accordance with San Joaquin County ordinances, St a la , and r�les nd regulations the San Joa i Local Health District, (Signed) -- .- a By------------------------------•--------------•------------- ------ � � an rat ar _______ {Title) —__ _ Plot plan, showing size of lot, location of system in relation to wells, ildings, etc. can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------ APPLICATION ACCEPTED BY ------------------------ ------ DATE , REVIEWED BY �." --- DATE UILDING PERMIT155UED------•----------------------------------- ----- DATE-------] Alterations and/or recommendations: ------------------ ----- •--------------------------------- F1NAL INSPECTION BY------------ =-�l ' --------------------------------- Date----,/_;2_77��— � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree? 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1.57 EP.CO.