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APPLICATION FOR SANITATION PERMIT Permit No. ...FSf .._ (Complete in Duplicate) w A.— •..41 Date Issued Applica+ion 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 Ordinanc 549. JOB ADDRESS AND LOCATION..--- T - ra,,W - Owners Name--- f- _[_ .. - --- --- , Phone.-----------•------- Address ---------------•---- ---- Contraetor's Name--- --- ' ------------ ®spa tri nt House - --------- -s � ------ ------ Phon;�� 7 ----•- Installation will serve: Residence ❑ Commercial ❑ Trailer Cour} ❑ ' Motel ❑ Other [] Number of living units: j____ Number of bedrooms __umber of baths _ -- Lot size --------- :)!( j Water Supply: Public system ❑ `Community system ❑ Private epth to Water Table -------- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobefo_Hardpan ❑ Previous Application Made: Ye; ❑>Na❑ New,Construction: Yes 9-"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer wer is available within 200 feet.) Septic Tank: Distance from nearest well--.�p,--__Distance from foundation___ -- . �--- ------ -.Material---------fir'----{ce�-e� ----------- Liquid • No. of.eompari encs____ _. Size_ - ------ - --- -' �� Liquid depth 4.0----------Capacity--- .dam - a � E Disposal Field: Distance from nearest w0-,5-C>-------Distance from foundation____. .....Distance to nearest lot line,__ Number of lines __.:______._____r_______________Length of each line_____:?-b- 71 of trench.___-..___71#,1 y r Type oT filter;material__jr ._,____..__..Depth of filter material_...'__ � ___._�otal length________--L„ Z--________ - i .� � f Seep ge Pit: Distance to nearest well_,« ____--Distance from foundation___ __/,- - ,/ �j_.__..bistance to nearest lot line______._.__ Number of pits''----- ---'------Lining material--, Size: Diameter_-'---- -------,-_.Depth-----.---car p i ------------ Cesspool: �zeaDia titer nearest well----------------- ------------- -Detthce from foundation:---____.-----------Lining material----------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ___.----`------------------------- ---- ___.___Distance from nearest❑ building______________________ •--------------- Distance to neaFest lot line --------------'- -----------•------•----•--------------- • Remodeling and/or repairing (describe):-----------_------------------------------------------------------------------------- -------------------------------- -----------------------------•------- -------------------------------------------------------------------I-------------------------------------------------------------------------------- -------------------------------------------------------------- I ----- -------- 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, an ules and regulations of the San Joaquin Local Health District. DAY& NIGHT (Signed) � �x_5erv:cs. ,a• Elr�c+rado 7048relation to wellner and/or Contractor) By: - ' Y ------------------------- --------(Title)------' (Plot plan, showing size of lo+ location of s em in s, buildings, a+c., can be placed on reverse side i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------------------------ DATE.:Fl;�--,-•----•--------'--___- REVIEWEDBY ' - ' ' ------------------------------------ -'--- ------------ -------------- DATE__. UlLDING PERMIT ISSUED =. --------- ---------------------------------- DATE--- - -- --------------------------------------- Aterations and/or recommendations:.,--------------- ----------_._..-- { --.------- - -------' -- --- -- --------------------------------------------------•---------------•------ ---------------------------•-----'•-------------- --------------- ------ ----- - .. --------•----------------- = -------- ---------------------'-' ---- --- --i - ' . FINAL INSPECTION ;- `rR ✓�' SZ r' ' --___----Y_ Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stteet 132 Sycamore Street 914 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California ES-9-2M 1454x6 n',wo on p2-sa h S