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APPLICATION FOR SANITATION PERMIT Permit No. __fit l._ u (Complete in Duplicate] Date IssuedApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described). pP Ordinance No. 549. :- r . r � � . -- This a lication is made m compliance with Count Or . - - - ---------------- ------------------------------ C PP P Y C JOB ADDRESS AND LOCATION__.. 's ---- =�L ��= I Owner's Name----.-'V221,0------- _ _ : _ - r , . ! Phone___ - ,. - F = f b t Address --------------------------- Contractor`s Name------___-- ,.# /tom ---- Phone------ -------------- ------------- --- ----- -- - ----- ---- ------ - ; Installation will serve. Residence 'Apartment House ❑ Commercial ❑ Trailer Court E] Mote l ❑ Other ❑ F - mber of baths __ _ Lot size/ `--•l - i Nu Number of living units:-_/--t:Number of bedroom t _ r a -r-- _... Water Supply: Public system`` �C�ommunity system E]' Private .❑' 'Depth to Water Table_ `ft. Character of soil to a depth of 3 feet:. Sand El Gravel F1- Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe [ ardpan ❑ Previous Application Made: Yes El No R New Construction•i- Yes ❑ No FN4A/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , # (No septic tank or'cesspool permitted-if-public sewer is available within 200 feet.] Sept' ank: Distance from nearest well-_______ ____ __Distance from foundation--.--;'_______-------Material-_,____--_____..__-__- _.____...___-..----_ --. No.,of compa'rtments------------------ Size Liquid depth Capacity = -: - t i Disp sal ield: Distance'from near'st;well--------------�Distance offrom line foundation_-----__.---}------W�d nce to riearest lot line__-.__...____..__ th'of`trench ------------------- 'N ---- ------ --- -, 'NumlJer of lines g 1 l " '.Type of filter material ":`_' '-k _ Depth of filter material_.__; ------ !_.__.Tota! length.......--_.---------------------- s t pag it ;" ;`�Dietance to neares�well` Distancs. om fou ation - .D'.t. nye to nearest lot ]iiia- Size: Diameter_ -r ___.De tn___ ---------------- See Linin material -, �✓ P f1 1�1 Ar Number of pits-�---�--:-----;-.f g f� ---- I ------- -� p Cesspool: Distance fror' nearest well-________________Distance from foundation-- _____- dining material__.- als. ,Size: Diameter__,.---k-=------------.---------- Depth_----------- ----------------------------- -• - `----Liquid Capacity--------- ------------- g ❑ Distance from nearest well....................----- - Distance from nearest building'-----------_-____-- ---- --------- Pnvy: ------- F-1 Distance-tornearest lot line. '_`....:"-'.," -- ---- ------ --------------------------------------- --- --- - -------------------------- Remodeling and/or repairing (describe}:_- = = ------------= ----------------------------- ' ' -----------------=-------------------------- --------------------------- ------------- ----=-------------------------- - r ► f , ----------------------------------------------- I hereb certify that I have prepared this and that the work will be + I f -------'------------------•------------ --- -------------------- -------------------------------- ------------------ -- ---- • -- _ _ � done in accordance with San Joaquin County ordinances, State laws, a rules and r - lations of the San Joaquin Local Healt`District. l l ------------------------- (Signed) r c ------- -- v `� t ..____.___--•-- -- --- Contractor) ( ----(Title`- {� (Plot plan, showing size of lot cation'of system in relation to wells, buildings, etc:, can be laced on reverse fide]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- --- DATE_ �� - QATE -1---------------------•---------------- ,REVIEWED BY ==" ------------- BUILDING PERMIT-ISSUED ------ -- -------- DATE--------_I-y�- -----=-- Alterations and/or-recommendations:__ ___.. -- --------••-------•It-------------- } - .. f-----F --------------------------- --- ---- ----------------------- -------- ------"y = =' -- _ - --------- ••-- ---V----- - - - �. ,, , , ..., -- - - --- ------------------ '------- -------- --------------------------- --.- --------------- ------- - `. l�tr} r=. .,. .Date-- " I FINAL INSPECTION BY: --- - SAN JOAQUIN LOCAL-HEALTH DISTRICT ° 132 S Sycamore $free{ 814 North "C"Street 130 South American Street 300 West Qe# $treat '+ Y w $ Stock+on, California Lodi, California ' ' Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO.