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jkl S /* 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 L CATION---"S_' 1--- -�-�-F-+-4- VA----------------------•------------------ ------ -- -------------------------------------------------------------------------------------------------------- �}�j,, - Phone Owner's Name------(?,- !sL�l f Address Z_gJ...[. ` �' -------•---•-------------------------- -----•-----------•------ �} Contractor's Name---- 1�14L= �'�'��D eta/----------------------- ----------------- Phone.__V---q_----------------- Installation will serve: Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- I--- Number of bedrooms _+Z.._ Number of baths __.l____ Lot size __y�_�_�©� - - ------------------------------------- Wafer Supply: Public system [j4 Community system ❑ Private ❑ Depth to Water Table __YA�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91 Hardpan ❑ Previous Application Made: Yes ❑ No EK New Construction: Yes 50 No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welf-----------------Distance from foundation--------------------Material------------------------.___________-________-__. ❑ No. of compartments- ----- ----- ------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line--------.________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-------------r---------Total length---------------------------------0__ _____ Seepage Pit: Distance to nearest well_zAr2,4-----------Distance from foundation__-/_P_____________Distance to nearest lot line--'e -____----_ Number of pits------/-------------Lining material___ fr -_ _1E W_4--------Size: Dia meter-_ 13------------Depth----4.57- --------------- _ Cesspool: Distance from nearest well_______________Distance from foundation--------------------Lining material___-_______---------------------_____ F1 Size: Diameter------------------ ------ ------Depth-------------------------------------------------.--Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building____-___________________________------. ❑ Distance to nearest lot line-------------------------- --------------------•-------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------••------------------------------------------------------------ ------------------------------------------------------------------------------ ----------------------------------- ---------•--------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------- 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. Owner and/or Contractor $y:. ------------------ -- ------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------------------------------------------------------------ DATE----- r f `��----------------------------- REVIEWEDBY-------------------------------- ------------ -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations-----------------------------------------------------------------------------------•------------------------•-•------------------------------- �tD `'il -- - --------------------------------------------------------------------- -------•------------------------------ --------------------------------------- ----- ------------------------------------- ` s' 7 FINALINSPECTION BY-- --------------------------------------- -------------------- Date----------------- ------------ -• �------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1-57 F.P.CQ_