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>> APPLICATION FOR SANITATION PERMIT Permit No. ___._j 2 ....___. (Complete in Duplicate) � Date Issued ....._/-71-_5"-�"- q'A Application is hereb made to the San Joaquin Local Health District fora permit to construct and install fhe k herein ?, ribed. ; Th is made in compliance withCountyOrdinance No. 549. p j� C�ie JOB ADDRESS AND LOCATION. . ------ Y-14A ---- Owner's Name------L_Q.L t C Phone.---., = ---------------- ----- •---------------------- ------------ --------------- : , Address-------------------- `- = .. ---------------- -------•------------==-- ----------------------=----------- Contractors Name----- ----------------=----------------""------------------------------------------------------------------- Phone----------------------------------- Installation will serve: !Residence ❑ Apar+rrient House ❑ Commercial ❑ Trailer urt ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths 2a___ r`f size 12?-0-41----/0-0-------------.------------ Water Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table sft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan❑ Y I Previous Application Made: Yes [] No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: # € (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Materi°a_Ch r ___ Y_Septic Tank: Disfance from nearest well------0-U- Distance from found tion_________ Liquid de th_ -----------. Ca acitY _O C_ ' No, of compartments__.__.�___.____-- -Size__ _ QC { Disposal Field: Distance from nearest weir 0-_____Distance from foundatio 0__,______-Distance to nearest lot lire____________ Number of lines________ _ -----------Length of each line_____- _-- Width'of french----- - --•-'.---..-----_".". -- ----=------- ' � Type of filter material___ �G -----Depth of filter material___f Total length___.__. ____________________._ i Seepage Pit: Distance to nearest well_____________---___Distance from foundation_---------------------Distance tc nearest lot line_-__.-.-.__.___.. ❑ Number of pits:-----------:-:------Lining material-----------------------Size: Diameter-- .___---------------.Depth----------------------------------- Cesspool: --__--- ------.__------ Size: Diameter_!---- --- ------------:- ----------.De th-------- ------ . 2 Li ui.d Ca vial `- 3____.L"inin mater 1 Cesspool: Distance from nearest well________________Distance from foundation_____' Lining ❑. p - -Distance fro -------- q p city----------------------------gals. �~ Priv Distance from nearest well_________________________________4.~___''__.`_ m nearest building ❑ Distance to nearest lot line________-___-------------------------------- -- -- ; iRemodeling and/or repairing (describe}-------------------------------------------------------------------------------------------------•-------------- ----------------------------------------- --------------------------------------------------------------------------------------=-----------------------•--------------------- - ----------------------- i E ti I hereby certify that I have prepared this application and that the work will be done in accordance with-San Joaquin County ordinances, S+ate laws, and rules and rr lations of the San Joaquin Local Health'District.` q �` --- ------- -------------------------------=-------- ---------------------- - (Signed)-"""_" •------_ � -------- --- -- • (Owner and/or Contract�4\ ------------ Title -------------------= � (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- -- ------------'DATE---/fly -----•---------- .- REVIEWED BY-------- -------------------- ----- ------ -- --- --- -----------=--------------------`DATE-------- ��C� -------------------- BUILD]NG PERMIT ISSUED ----- ----------------- =: DATE r `- Alterations and r recom ndations: - r� - --- ---- --- - -- ---------- -- =- -------^----•-•--- -------------------- t -- ---- - - ---------------------------------------------- ----------------------------------t------------- -----------------•-----=------------------------------------------------------•-------------------------------------- ---- t FINAL INSPECTION' BY:-=-- -- --'•--------�- -----_ Date 1 ` c�� ct' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California x F Manteca. California Tracy, California ES-9-21A Revises 1-57 F.P.CO.