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16 APPLICATION FOR SANITATION PERMIT Permit No_ _ _____________ (Complete in Duplicate) t .-x Date Issued - j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein c[escribed. This application is made in compliance with County Ordinance No. 549. �:�� -r4 +4 f{0 s4 L115—: JOB ADDRESS AND LOCATION----tY2 l-1'`"'----------------------- 7 ' ' L`'" C �� a- . N� _�F3�� -�"--w ----�M- -?�----3 --,,�G--- ------- g� Owner's Name---- ------- l f.�'�--------- t�? 1 Phone �-i- s_I_ry -j Address---------------------- �� `�'� k'L' Contractor's Name__------ 11--- �frl,-.c_v.[+ Phone ------ Installation will serve: Residence 63"�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __)_-__ Number of bedrooms __- Number of baths _L'Lot size ______ _f --_______________________________ Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table ft. Character Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O"Hardpan ❑ Previous Application Made: Yes ❑ No E--"'New Construction: Yes ["'No ❑ FHA/VA: Yes ❑ No 0l"- 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"}'�S�+i-t-____-Distance from fo ndation___j��_-___.____.Material___ _ '� _____._.._F____. ❑ No. of compartments---7------------------ -___Liquid depth______ a;.�__ Capacity----- -.___ Disposal.Field: Distance from nearest well tit -__-Distance from foundation___f_h-----------Distance to nearest lot line___.----____. ?_eco i- -lines ---- Width of +reach____ _ ___--------------------- - Type of filter material.__ tN�_________Depth of filter material-----(A_..............Total length------- _-,-x-------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.--- ------------------Dept h--------------------------------- Cesspool: Distance from nearest well___:__:----------Distance from foundation.___--------------- Lining material-------------------------------------- 0 Size: Diameter-------------------------:------------Depth--------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- 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. .+ (Signed)-- c l l,'}_ <c c--z ------------------------------------------------------------------------------------------------------(Owner and/or Contractor) BY: -- -------------------------------(Title)----------------------------------------------------------- --- (Plot plan, 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------------- +1 f tri r ��'DATE ` ------------------- REVIEWEDBY------------------------------------------------------------ ------- ---- ------------------------------------------ DATE----- BUILDING PERMIT ISSUED---------------------------- - --------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------------------------------------- ---------------------------------------•------------------------------------------------------- ----------------------------------------sra -------------------------------------------------------------sra --------a f K--------------- -----------Figs` ----------------------------------- -------------4C-P�a-H---------- •----©,!-�: T,R- '-----------t-FLN111 ------------------------- FINAL INSPEC - -�_' -- ----------- ----- Date7---------------------- 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 FY.CO.