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fj APPLICATION FOR SANITATION PERMIT Permit No. ___!_4__3.`-- I ,,;,/(Complete in Duplicate) '� 1 1 ' Date Issued T T 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-------�`_-- -1�----G ----- 1 ----------------------------- ------------------•---------/----- -------------- - _©Y7'7. M Owner's Name_____,cam-�------- ��'-s llD ---------------------------------------------------------------------------------------- Phone_ a � .Address------•--_7.'" r�✓!l� --------------- - -------------------- - ----------------------- I' :Contractor's Name-----------/V.......4. -------- �T'�r=. f'h�11� �e�./ _ Phone.. Installation will serve: Residence []' Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ zzv-Number of living-units:--!___-Number of bedrooms ___i__ Number of baths --4-- Lot size -_-_YB:____If --------------------------------- -Water Supply: Public system &3/- Community system ❑ Private ❑ Depth to Wafer Table ft.T • t - 'Eharactar of soil.t0 a depth of`3 feet: Sand E] Gravel [ISandy Loam ElClay Loam ElClay ❑ Adobe Hardpan E] Previous Application Made: Yes ❑ No V New Construction: Yes ❑ No �FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND'S'PECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: - I Distance._from_nearesf well_________________Distance from foundation--------------------Materiai-------------------------------------------------- (a 7-1WUZl Tip � -------------------------Size--------•------------------- ---Liquid depth--------------- ----------Capacity----------------------- Disposal Field: Diosiance f omrnearest�we' Il"_ __ a isfance from foundation__`-_l _---__Distance to nearest to#)ine__-_�______-- Number of lines----------'-- s�- Length of each line----- ----------------Width of trench_----cis.-----_------------------- 5411' `� .4. Type of filter materiaka_�.:_'_ epth of filter material_____ ___`__Total length.----��__ ______________------ Seepa~e'Pit: , Distance to nearest we ____e�___----___ Distance fC� foundation____ ___ _______.D tante to nearest lot line-..-.-f __ Number of pits______------------Lining material _._r '�-'.Size: Diameter__ __. -1--______..Dept h------ ----------------------- Cesspool: Distance from.nearest weil-----------------Distance from foundation_----.--------------Lining materia___.----._--______________________- ❑ Size: Diameter------ ------------------------------Depth--------------------------------------------------- Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------______________-----___._. ❑ Distance to nearest lot line--------- _ --------------------------------------------------------------------------------------------------- - --------- ----------- Remodeling,and/or repairing(describe):----- ��______4.�1�t11� ----- „ T ------ Zoet� •-•-/�'��'��• -W------/_ s.Y7- ' �_------- •z ------------------------------------- ------------------------------------------------------------------------------------------- I hereby"certify-fhat l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. $i ed f✓`�'��' ----- ----------- ------------------------- -------------(Owner and/or Contracfor1 .: -- - Tale (Plot,olan, 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 W4- --- ------ REVIEWEDBY------------------------------------- --------- - DATE 4- BUILDING PERMIT ISSUED------------------------•- - DATE----------- ATE 1 ------ ---- Alterations and/or recommendations----------------- --------------------- -------------------------------------------------------------------------------------------------------•------------ ------------------------ ----------------------------------------------•------------------------------ - ------------- ------------------------------------q FINAL INSPECTION BY----------- --- --------- ------------- Date _ j.vi ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street y 132 Sycamore Street 814 North "C” Street Stockton, California Lodi,,California Manteca, California Tracy, California ES--9-2M , Rovisea 1.57 F.P.00.