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J Foe)& C ve r'eVI) y 2 I APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) Date Issued ......_?/,,�f .dr[s 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. S A� 7 JOB ADDRESS AND LOCATION.-...I j--Qd----LF '- lLf�z�-� 1 t`!fC' .�"_._ lf'/, "----- Owner's Name 'TT l I �r -------------------------------- - ------ Phone..........-------------•----------• Address------------•a = I,d0 �fl -----" �----------------------- -------•,---•-------••,-. Contractor's Nam .r { � �4 - �trc� ------------------------------------------ PhoneX1.,7Q_1�1� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_-__ Number of bedrooms -1___ Number of baths .1___ Lot size ...4!�17.A---6f?i, ............ Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Claylg—Adobe Hardpan ❑ Previous Application Made: Yes ❑ No^4New Construction: Yes Dg___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_1_0_0_�__Distance from foundation---/ _�.____...Materialr9: ._ _ p No. of compartments___,Z-------------- � Liquid depth_ ia *'-_.__,.-Capacity A(. �_r i tante to nearest lot line-_- Disposal Field: Distance from Weare I) (0 Q. _Distance rom foundatjQ�__� D� Number of lines._ _______ _______ ___________Length of each line.. __� d�Nidth of trench...,2,�!'...._..._.._..... '-0 Type of filter material_____ -_- --__-_Depth of filter material-----/F '{_._____Total length-1.0--plf l-------------•---..__.. G cd Seepage Pit: Distance to nearest well ___________________Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter...... ...............Depth_-.------------------_-----_-- Cesspool: _--__ -•-_..______..--Cesspool• Distance from nearest well •.___.-_____Distance from foundation--------------------Lining material_ ..........� ❑ Size: Diameter--------------------------------------Depth----- --------- ----- ---- --------------Liquid Capacity •--_---. .. -_.....---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------,-------- (2�_ ❑ Distance to nearest lot line-------------------------------------- ----------------------------------••------•- •--•--••--•--------•-•---- Remodeling and/or repairing (describe) ------------------------------------------------------------•----------------•------------------•.......... ....................... --------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------........................................ -------------------------------------------------------------•-•--=-----------------•---•---•------••------------------•---.----------- -------------------------------------------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, and rules -and regulations 'joff'the San Joaquin Local Health District. (Signed) �.� � �t={t 9�7 J �1 t-C.-1T: ll/�C-�------------------------------ -----• ---- Contracto ' s G By:...... ........................................................... -•--- ------------------------(Title)--------------------------------------------------------------- (Plot -------- -----(Title)-------------------------•-- (Plot plan, showing size of lot, location of system i elation to wells, Kildings, etc., can be placed on reverse side). FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY----- -- -kms" -------------------------- ---------------•------------------ DATE-----1 --- -•-.S. _ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------. ...••-- BUILDINGPERMIT ISSUED---------------------- ----------------------------------------------------------•------------------- DATE-------------------------•-------- .............. Alterationsand/or recommendations---------------------------------------------------•------------------------------------------•------------•-•----------------•------------------------------ --- -• -----------------------•---------- ----•---2-- -----• - -, FINAL INSPECTION BY%.-------- --- ---- ---------- Date------ ----------- ----------------- . .._..---•----.--•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.CO.