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APPLICATION 1=0R SANITATION PERMIT Permit No. _lp_ ----------- (Complete ------(Complete in Duplicate) J .z Date Issued r'`7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap�plicafiori is made in compliance with County Ordinance No. 549. . •i~C.T`�F•f r:ti1,S' .Sa��T—;, � it JOB ADDRESS AND LOCATION___fil��s.__.__..___ - -- ------------------------------ Owner's Name ' _..11_P'��` } --------------- Phone------------•------•--•---•-"-•---- Address----------14_,9.7_- ---- ---------------- -----dam" Contractor's Name------d _� _]t •----------------------------------------------------------------------------------- ------------------ Phone-----------------------.. i r Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !� Number of living units:/_____ Number of bedrooms Y---_ Number of baths Lot size �_ � a✓......................... Water Supply: Public system ❑ Community system ❑ Private jVDepth to Water Table _ _Q__ ft. II Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan;❑ r1 Previous Application Made: Yes ❑ No New Construction: Yes;I 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 well-47a-------Distance from foundation/P ---------- ________________ --J A01 No. of compartments----- ----------------Size__'---; ----------_..Liquid depth--- ----------------Capacityz ___-- -- Disposal Field: Distance from nearest well_J-0----------Distance from foundation_ 17_.__.._._.Distance to nearest lot line_s__y'"..__. ] Number of lines----- -- Length of each line---1,0�V------------------Width of trench:__;-�- --------------- --_-- Type of filter materia <-___ _ __- Depth of filter material___ � '�-______ g -- � - - . Tata! len th__A-"---=-------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----._____ j] Number of pits--- -----;----------Lining material---------------------- Size: Diameter------------------------Depth-- ------------------------- r. � Cesspool: Distance from nearest well------------------ from foundation--------------------Lining material-___-.._______.____________ ._-�___� � ❑ Size: Diameter-------------------- ----------- ----Depth----------------------------------------------------Liquid Capacity----------------------------geld Privy:,. Distance from nearest well-------------------------------------------------Distance from nearest.building-------------------------:----------_--- h ❑ Distance to nearest lot line------------------------------------------------------------------------ ------------- ----T Remodeling and/or repairing (describe):---------.____ Y 1- ------------------------------------=---------------------------- ---------------------------•------------------------ -----•--------------- ---------------------------------------------------------------------------------------! ---------------------------------_-------_------------------------------------------------------------------_____________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and r and regulations of +he San Joaquin Local Health District. r (Signed) I ---`---------------------------------------------- -------------------------------------- - --- ---------------------.-------{Owner and/or Con-tractor) By--------------------------------------------------------------------------------------------- - ------------------------(Title)-------------------- - (Plot plan, showing size of lot;location of•sys+em in:rela+ion to'-wells,- buildings; etc., can be placed on reverse side). — = FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY___ ___________ __ ______ -- - -- ----------------------•------------•-------------- ------ DATE--I�-'-��-�`�p--------------- - ---°----- REVIEWEDBY----------------------------------------- --- - - - ----------------------------=---------------------- ---------- DATE------------------------------ BUILDING -------BUILDING PERMIT ISSUED----------------------------•------------------------------------------------------- ------- -------- DATE-------------------------------------------- I Alterationsand/or recommendations:----------------- ------------------------------------------------------------------------------•--------- --•----------- -----------------------------Il .. --------------------------•--------•---------------------------------------- ----------- -------------------------•-------•-----••---------------•---••-----•------------------ ------------------------------------------------------------ -----•----------------------------------- ---- ------------------------------------------- ----- FINAL INSPECTION BY:.- Hate tk � 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 o p ES-9-2M , Revised 1.57 F P.CO. i�