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qd �vv APPLICATION FOR SANITATION PERMIT Permit No. ___ ------_- (Complete in Duplicate) Date Issued _"_________--- 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..__. _ �' f�U k � �k Owners Name--- Y= .(---.-"' " --...... A_. ,5'_ Lt - "V 1-'� ` J Phone EAddress ---------------------- ---------------------•-•---------------------------------- Phone----f.-- d-._.. . Contractor's Name ----•-• -- ' lM Installation will serve: Residence []?_�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E! Number of living units: __. ___ Number of bedrooms_._ Number of baths :�7_ Lot size . _y � {___ _.i _._ ......... 1:Water Supply: Public system ❑ Commurtiity system ❑ Private Depth to Water Tablft:." Character of soil to a depth of,3 feet: Sandj Gravel E] Sandy Loam E] Clay Loam E] Clay ElAdobe 0---Hardpan E]Previous Application Made: Yes ❑' No` New Construction: Yes ❑ No ❑ FHA/VA: Yes R?' No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS:w ..� (No septic tank or'cesspool permif itted public sewer i as vailable within 200 feet.) �,J►� r Septic Tank: Distance from nearest w�l_j____ ______Distance from foundation_ -•.,...t:�,�. ... } ` Material I No..of cbmpar#ments_.---Z - rI A i acit)l Size-'+� 1� �1 �' (yap— _4- �] !i /H s 1Yra I1 Disposal Field. Distance from nearest . el .. __ .. _Dist,7,7rom foundation----1'9-'f.__.Distance to nearest lot line___'__- , Number of lines-_ .-_ . _-___.____Length of each l ed: Width of trenc ----- - i� !S Type of filter jnaterial__ _ -_. _______Depth -of filter material_____________ __ .Total length._ ______ ,i Seepage it: Distance to nearestiwell__/ -1 --- foundaticn__Y_ -(-.,-:-.Distance to nearest lot line___________ ________ Ir =.Linin material__, - '.r_._ _:_ _Size: Diameter__. �� Number of pits g � Depth---�-X�----------------" + Cesspool: Distance from nearest well-----------------Distance from foundation______________1_ ---.Lining material_______..__________________.__. , ❑ Size: Diameter-------{ Depth-------------------------------- ---------i----Liquid Capacity----------------------------gals. i Priv Distance from nearest welt______--------------------------------------_'. ___________ __ ____._ ---------- '. -•Distante from nearest building------------------------------------------- ❑ _ Distance to nearest*iot.line;__,�,�;�___ ____-----------------------' i .1f _ ! Remodeling and�/or repairing (describe):--------------- --- l --- -----------------------••-------- i E � I " - .✓ it --- 1 Ir �� ___Y__'._._.____._ ry __________________________ _______ . !I I hereby cerfifytbat 1 have prepared this application and fhat�the work will be-done in accordance with San Joaquin County € ordinances, State lags, a rules and regula 'ons of the San .loagdin Local Health District. J' ' . T r Contractor(Si (Signed) . - --- ---- B _ oction of system in,relatid to wells buildin can be placed on reverse side). , s N.. ' - can plan, showing size of lot r k: I FOR DEPARTIVIEtVT USE ONLY I ! Ai APPLICATION ACCEPTED YY AN " y -tW�--------�,�--------Q DATI ---------------------------------- ik w�� -(S.. � � y�� _ _ �^ ___ � �.' V S� REVIEWED BY "" + fir° ` \ `� ------ DATE 1BUILDING PERMIT ISSUED__ ....-- -`-.+...... t�'^ `-- --- _ ��' v �I � -----�-`---------- -- DATE------------------------------------------------------------ # Alterations nd/or;r ommendatio�------------------ ------------- -- _ ----- _ sI . - ��-----------r ---- . .__ fc4sr=C_y� �5- ----tA4T'-�-- --- �-0�2--�-'''-'i.^�J- -- -----G '•-----•--------------'---- P ------„----------=-------------------------------------------------------- ------------ ---------------------------------------------------------------------------------- ---------•----------------------•--------•-------- € t FINAL INSPECTION BY:---- s � �' .(.,_¢�1 -_~. Date------ ',.-- --------------------I-•---- ---------------- I! SAN 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 Y° S i E5-4-2M Revises 1.57 F.P.Co'