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et APPLICATION FOR SANITATION PERMIT Permit No. ___ L___------G-_ (Complete in Duplicate) c 1 Date Issued 111_91 Application is hereby made to the San`Joaquin Local Health District for a permit to construct and install the work herein described. Th€s application is made-in compliance w€th County Ordinance No. 549. JOB ADDRESS AND LOCATION___I __ ---Lr[1---- -- --_-------_--- --------------- } Owner's Name------ -•- --------------- Phone------ --•-------------- -----•-•---------------- - Address- 7 _E_ Contractor's Name--- ' - --------------------------•----------- ---------- ------- ----------- --•--- ------- -------------- -------- ----------------------------- ----------------------- ----------------•----- Phone Installation will serve: Residence }- Apartment House ❑ Commercial ❑ 'Trailer Court urt ❑ Motel ❑ Other ❑ Number of living units: ____ _-- Number of bedrooms -__ _Number of baths ___ Lot size ___'_"- < „ ._ � 02 U 6)--------------------- Water Supply; 'Public system . Communify system-❑ -Private ❑ Depth to Water 4 able : ____ ff.' Character,of soil to a#depth of 3 feet: , Sand ❑ Gra elr❑ Sandyoa�X Clay LoamI ❑ Clay F1Adobe E] Hardpan El Previous Application Made: Yes E] Noi New ConstructionlYes[ No El FHA/VA:'.Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic.tank.or cesspool permitted if u licsewer is available within 200 feet.) dam—__ _ e p - Size_ --• A0--- -----Material_- _ &-,r Septic No, of compartments is -Distance from.. Wr-�` _ : Distance from found Liquid depth___-----------------I!Capacity__iQ_U-- �C Disposal Field: Distance from neares-f well__:____f�_.-'_Dista ce fio fo ndationI Q ,��-______-_Distance to nearest lot Ime"______ Number of lines___"_-- ----- �� Length of each like__-- 1--- -Width of trench---�,7"Y_-------------------- D ___------ / g , -- r � - 11 Type of filter mater:al<-__ -t I. y Depth of filter maferial__ ��, - ------------Total Length------� ---------------- --------- Seepage Pit: R Distance to nearestwelL�::__ '_Dista ce'fror.n flundafion_Y________________Distance•to nearest'lot'line______'-_ ft - ❑ Number of pits............ _ _ -1-in--i g material--------___ L-#-.Size: Diameter_____________________ _Depth_.--___ Cesspool: Distance from nearest'wel€________ _____Distance from foundation-------------..____.Lining material______--______- _-____- Y " x ❑' Size: Diameter_ _'.- Depth-------- , Liquid-Capacity Privy: Distance from nearest well _._ ____________ _____________ j---D;stance from nearest building-----------------..-___. - :- Distance to nearest - - --- Remodeling and/or repairing (describe)----=--------- -----------= i_----------- --•--------------------------•------ ------------------------m-------------------- ----------------------------- ---------------------------------------------- ---------------- ------------------------------------ If ----------------••--------------- ----------------- •----------•------•-•-------- --------------- ------- - p=----------•----------`pp-------------------------------------------- I herebycertifythat I have re ared this application and that the work will be done in accordance wi ' th Sart Joaquin Coun i ordinances, State laws, and rules and regulations of the San Joaquin Laical Health District. Si ned -- ------------------------------- _ .,. 9 ) ---- -------- ------------------- --------- -------- w - - _- - ------ and/or Contractor) - -------------------; -------------------(Title)---- w (Plot plan, showing of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------- DATE---- y, • T , -- " ... • + --i----------_ -REVIEWED BY-----------5--------------------- �-=------------------------------- DATE------/.�-BUILDING PERMIT ISSUED-------------r-=----------------- - - ------------------- ----------------------------------- - DATE Alterations and/or.recommendafionsz__ _____________ _ ____/_ `- •-----=-------------------- r-----A/� �-------- -•- ------------------------------------ ------------------------------------I--Q-�--f-F------------_-------1--J----r----_-_-_- -------=---------- r-------- - Z-4d:-----lfA ------� ---- --- u-------C2-- ! - " 21 I AL T�1SP T! N BY:- ----------� `:;;--•------------------- ------------------ Date---------------------- 'IV - ----------------''" LOCAL HEALTH DISTRICT a 130 South American Street 300 Wes+ ak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4—, 2 M Revised 1.57 F-P.CO.