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APPLICATION FOR SANITATION PERMIT Permit No. ._1Q_1l J.__ (Complete in Duplicate) Date Issued __./��A�7...- 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. r3 _ 23,0..-p7 JOB ADDRESS AND LOCA40N .., ---------�-- ----------�.�`�"---.._....�- --------- -- ---- Owner's Name.... -•- - --- e<6ih<L------- ----------- ....._------------------------ - -� � Phone......................--•--------- 11 1 Address---------- ...._r._- - -- ------•Yff--� � _ Contractor's Named--•-f-----------•-----•-----••-------------------------------------- - - =-� _ Phone - _ _ Installation will serve: Residence Q ' Apartment House ❑ Commercial Q Trailer.Court ❑ Motel 0 Other Q Number of living units: 1 Number of bedrooms __�^-.. Number of baths �y?''fLot size -_' e Water Supply: Public system ❑ Community system ❑^Private k] Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ 'Sandy"Loam []'--(;lay Loam Clay 0 Adobe F] Hardpan F] Previous Application Made: Yes ❑ No � New Construction: Yes ® No ❑ FHA/VA: Yes ❑• No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i r(No septic tank or cesspool permitted.if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--o 0...... Distance fr m foundation-1. Material.- w......... No. of compartments-_ _._-_-------Size__ .'t_iS'........Li ruidxde t '-.�..........Ca acit Pp Disposal Field: Distance from nearest well m__._..Distance from foundation__T----{:..Distance to nearest lot line..�v__._...-. i Number of lines.________I/__ ---._,�..___ ength of each line___1q.Q..._!_-___-Width of trench_- ` . YP ta� P Type of materala'_�yr De th of filter mate'r'ral_Z,Y_.•�.......Total lengfih..___-,(..a'_9-_-.--_--.___..-_-.___ Seepage Pit: Distance to nearest well•_-------_---------Distance from foundation------------------_Distance to nearest lot line-------------- ❑ Number of pits________ _________Lining ma+eriai_.---•--------------..-Size:-Diameter----------f-- Vit"_ - Depth------------------------........ Cesspool: Distance from nearest well-------:"...Distance from foundation_.__________.__..Lining material----_................................ Size: Diameter._.l..............:.. Depth..........!__.t..._ .......:- ..Liquid Capacity........................_.9als. '.Privy: Distahce from.nearest well_.-_____........_.........-.......-........Dista nce from nearest building----__-_---- �_____ Distance to nearest lot line__._.---_------------------ —------------------------------------------_ __......._-----------------•-- f Remodeling and/or repairing (describe):..........................................------••-----------------------•-••-----------------------------• _..... - 1 - - -- ------........._-_-_-M Y_.._N_�._ _ ------------- -- - - -- --------------------------------------------------- -- ..... --_ _ ------- --------------------------------------------------------..................................................---•-•------•----------------•-----------•---•----••---------.------.._........._..--•--•----•-........ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws, and rules and regulations of the San Joaquin Local Health District. (Signed) --- �-i !s ..................._.............................---------------_......................-----(Owner and/or Contractor) BY= d!-_.... � ................................-----...._-�---•--(TitleP-_--------------------------- ----------••----_ _- (Plot plan, show) g size of lot, location of system in relation to wells, buildings; etc.;can be- laced-on ieverie side). - t , f FOR DEPARTMENT USE ONLY p I APPLICATION ACCEPTED BY.... •- -- REVIEW ED BY........................----•------'=----•-----------•--------------- --------------- .._.._._..____._ DATE..........--•--••.--------------------------------- BUILDINGPERMIT ISSUED.--.......-----'-----------------------------------------------•.................................. DATE..................._..........-................---------- terations and/or recommendations:..----.....--•-----.--------------'..-----•---------............_.___...._-•-----•--..---... ...................................................................................................---- ....-•----•---•-----------•----•--...--..-----_..... FINAL INSPECTION BY:��^ ;l-tI------------- - ---_----•--------•---- Date.- --�"-• __ S JOAQUIN LOCAL HEALTH DISTRICT I 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 • Revisee 1.57 F.P CO. i