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1� t( '11t,� APPLICATION FOR SANITATION PERMIT Permit No. .-1'aZ. ..... (Complete in Duplicate) Date issued _____ This Permit Expires 1 Year From Date Issued .,Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This applicatiori ris made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION----- fJ -- -----'- �� ;� --------Al-------� -------- ----------------------- Owner's Name---------- j-��-- --'---------------- ------------------------------ ------------------------------- ----------- Phone........--------------------------- Address _Q.�S -------- � ----------------------------------- ------- -- Contractor's Name_.-�.�! �� EE° �= - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.Z umber of bedrooms _ Number of baths _��Lot size A40-0-1y--,l.2—c-__--=----------------- Water Supply: Public system x Community system Private [-] -O0_-_Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes Hardpan E]Previous Application Made: Yes ❑ No J� New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑, \ ' TYPE{OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) I ` epti T Distance :from nearest well------------- ---Distance fsorn foundation-__-_--_-___--_____.Material_..-_-------____-___-.---_-__----..---..--_.__.. mpartments-- --'------------ -------Size------------•--•-------------- Liquid depth - Capacity Disp ua� Field: Distance from nearest/well. f�__ Distance from foundation _ -------Distance to nearest lot No. o co �]r"� Number of lines__ ___ ---__ _ Length of each line--------- -- Width of trench._Zf� j,5 Type of filter material__' � -�De 9 � --f;----- ------ (-�! ` pth of filter material---,/ ------------Total length--------f ------------------------- ,. .f ,. S cp Linin mat'tance from foundation___________________ .Distance to nearest lot line____._________.__ _-__Dis See Pit: Number of nstsrest-well_-�3 g erial' --t-----Size: Diameter-----------------------Depth--------------------------------- X Cesspool: Di'stance:from nearest well--------i.-----._Distance from foundation-_- -._-_.._..Lining material____-__.__-------------------------. 11 1 1 Priv Distance dearest well---=+'----- - ----�-{--��.<.+5;'� .F�-- ------------------------Liquid Capacity----- - -------------------gals. \ __ ._ _r Size: Diameter------------------ ---------- Depth--------- - i y. Distance from nearest building--------- ----------------__--------. . � Distance to nearest lot line- --:----- -- Remodeling and/or repairing (descriUeJ:_ .�---- ------- -------•-- -� 1------ -R�--------`- ------ -------- --- ----------- -5---------------------- _ iF - - -- - - ------ ------------ Le ------------------ ------•----- ---------------------------- ---------------------------------I-------------------------- -- I hereby certify the have prepared this application and that the work will bed in accordance with San Joaquin County ordinances, State law , an rules and regulations of the San aqu.rn Local Health is��ic+. ----- ----------------- -- ------------------------------ ---- -------------- -(Owner and/or Contractor) (Signed)--- ----- - BY: `--------- - ---- Tale �.�� ( � )------ (Plot plan, showing size of lot, location of system i relation to wells, building tc., can be placed on reverse side). FOR DEPARTMENT US�E ONLY APPLICATION ACCEPTED;BY--- . _-r- ".___ _ `�~� DATE----4----------- --- ------------------ REVIEWEDBY-------------------------------- ------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:------------------------ ------------ --------------------------------------------------- •------------------------------------ -------------------------- -•---------------------------------------------------•-•-------- ----- ------•---------------------------••---------------------•---------------------------------------------------------------------------------- ---- --- --------------- -------•---------------------------------------------------------------------------------------------------- ---------------------------------- -------- ----------------------------- ----------------------------------------------------------------------------------------.--------------------------------------...-._-----__ _ _ _ ._-.----__...__-- -__- __-_- .-_-.--__-_.----_ FINAL INSPECTION BY:: -----e_.•._� -------- ------- Date_...- -- r-- L- ------------------------------------------- SAN -- - - 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 U59 F.P.Co: