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y � APPLICATION FOR -� SANITATION PERMIT Permit No. .--fd__�-�� ` (Complete in Duplicate) Date Issued _-- 9�`` 7- I Applicatio is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with Count Ordinance No. 549. described. 1 ; JOB ADDRESS AND LOCATION..... 1 1 ----- _ ------•-----------------------------•--------------� I Owner's Name------- ---� G-� �-- - frT` - ------------------- --- = Phone --_- 4'- -,,7r4r Address. r ------ Contractor's Name ` Phone---•------------------------------- F' ----- _ �' `--} Installation will serve: Residence Apartment House ❑ Commercial r Number of living units: -� -: Number of bedrooms _- ---__ ❑ TraileCourt ❑ Motel ❑ Other ❑ a ' � Number of baths __..� Lot size�gff- d Wafer Supply: Publics stem -------•--- Y ["Y Commun'it s stem ❑ pY Y ❑ Private De th to Water TableCharacter of soil to a depth of 3 feet: San ❑ Gravel ❑ Sandy.Loam ❑ Clay Laam ❑ Clay f Previous Application Made: Yes No ❑ Adob� Hardpan [] ❑ � New Construction: Yes ❑ Na �N;4/VA: Yes [] No ,-� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if pub' sewer is�aila wit in 00 feet.) Septic Tank: Distance from nearest well!__--_--_ �j istance r m undaPon__.AP__--_.Mate ' No. of compartments----_ Siz ;Liquid depth ----- ----Capaci Disposal Field: Distance from nearest well.--._- Y - Y` d�t�-A+stance from foundation__ "_,Distance to nearest lot I LJ' Number of lines_-_- --- _ � --Len th of each line----- ""-- ---------- Type of filter material - p j I 'Width of trench- -- De th of filter material_--._/ --- ---,Total length---- ---------------------------- Seepage Pit; Distance to nearest well -__-- �"'� El Distance from foundation--_--_- _-----".Distance to nearest lot line--------------__ .� Number of its---------- ------- --Lining maternal---- -------- �-------Size: Diameter.------- ------- -----.Depth ------ --------•-------------• Cesspool: Distance fi•om nearest well----------------Distance from foundation-___""__--__-__•___ Lining material__-- "--.-.-_."-__-.-_--_--_ _-- , 0 Size: Diameter_--� - Depth r Liquid Capacity ------------------------gals. 4 Privy: Distance from nearest well--_ ".----- ----------------------`----Distance from nearest building❑. to nearest lot line--------------- --- ,�` g----------------- Distance ------------------------ ----------------i ----------- --------- Remodeling a or repairing (describe, . ; / -- --fie F'�-" _- ---_ --- - - "--__-... I hereby certify that I have prepared this application anhat the work will be done in accordance with San Joaquin County -------------------- ___ ordinances, Sta I , and rules and re afions of the- n.Jo uin Lo � � h District. (Signed)----•--- ---- - ------------------------ -.----.(Owner and/or Contractor) Y= : , ------ --- - Title Pot pian, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ----- DATE__ REVIEWED BY = -------------------------- BUILDING ------------------- - ---------------------------------•--. DATE---- PERMIT ISSUED----------------- i . - --- -- -•----------------- ---- ------------------------------------------------------ ---------- DATE-------------------------- ----- ations an o� r ommenda ' ns;-_� . _____-- _" " -- - - - I - /- ------- -- ---•--- ---- -. t-- „ .d�," - - ---------- -- �.-- . - ------------------- FINAL INSPECTION' BY:--------- ----- ........ _ i -------------•.............. ------- -- - ------- -- -- ------- ------------- - - SAN JOA QUIN LOCAL HEALTH DISTRICT 130 South American S+rest ix ` 300 West Oak Street 132 Sycamore Street „ „ Stock+on, California 814 NorthC Street Lodi, California Manteca, California . Tracy, California E5-4-2M , Revisecy 1-57 F.P.CO. -