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APPLICATION FOR SANITATION PERMIT PermR No. (Complete in Duplicate 8` 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------- 0----- - -- } l + r� -- -------------------------------- ------ Owner's Name--- - --'-----�-7�'r[--J?"-�-�-12-�- -------------- - ------ ------- -- ---- ---------------------------------------------- - Phone Address---- r.5j.4_ ------------------ -- - •------------------- ---------- Contractor's Name:-x 4 �,I/�l '------------------------------------------------------ Phone--------•-------------- - Installation will serve: Residence ❑ Apartment House QJ Commercial ❑ Trailer Court ❑ Motel ❑ Ot* [] Number of living units: __�T_ Number of bedrooms ---'7-- Number of baths ---7--- Lot size ___.tea-�!f2 c1-Q I !! ----------------------------------- Water Supply: Public system -jK Community system ❑ Private t] Depthto Water Table _rtt. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No Q FHA/VA: Yes ❑ No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.] - _ ti Septic Tank: Distance from nearest well-----------------Distance from foundation------------.------.Material C 1 ❑ No. of compartments---- --------------------Size--------------------------------Liquid depth---------------- ------Capacity--- - i n Disposal Field: Distance from nearest Lyell_! Distance from foundation.__$--r-----_.Distance to nearest lot Ii Number of lines___________' ----------------------Length of each line------------------------------Width of trench_--L _�� ._____---_-_ Type of filter materiai____.�--C_�f__------Depth of filter mafierial----� _��_____-__--Total length___._-`----_------- -------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------- ❑ Number of pits______________________Lining material--------------.--------Size: Diameter-------------------------Depth---------- ----------____--- __--._ -- An Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------_____---- �) ❑ Size: Diameter------------------------ Depth-.------ -----------Ilk-----------------------Liquid Capacity----•-------------------- -gals. Privy: Distance from nearest well________________~r_.=___________-_-________Distance from nearest building-------------------------------- `" Distance to nearest lot line ._`_____________._ ----------------------------------------------------------- Remodeling and repairing (describe):______ _ - "`,�---_---Q _5------ O7/fGtiYy •----------- ----------------------------------------------------------------------------------------------------- a ---------------------------------------- E I hereby certify that I 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. (Signed) � ( --------------------�---- BY= `f `-�-1e!.!�/C , (Owner and/or Contractor) 3 -- w --------------------------(Plot plan, showing size of lot, location of system in.re , dings, i etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-- .- ---------- -------------------------------------- - - DATE _. � REVIEWED BY - - ------ --------- ----- ---------- DATE BUILDING PERMIT ISSUED-------------------------------------------- - -- ---•---------•---------------------------._ DATE --------- Aiteratio jnd/or r omm nd ' rls:------------- ------ �. -------•---- -----------/-- -----s—------------/............ l7 ------- ----------------- --------------------- --------------------------------------------------------------- ey,_I��I"7---------------------- FINAL INSPECTION BY:. Date-j�7:V7_51 SAN JOAQUIN LOCAL HEALTH DISTRICT ? 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 'TM Stockton, California Lodi, California Mentees, California Tracy, California ES-9-2M , Revises 1-57 F.P.cO.