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„ _ ✓” APPLICATION FOR SANITATION PERMIT w Permit No. __`�_-�� _`7... (Complete in Duplicate) a `7�� .� �� r __ ' .. Date Issued --_111AT_� Lye Application is hereby made to the San Joaquin Local Health District for a permit to consfruct and install the work herein described. This application is made in-c liance with County OrdigAnce No. 549. , _ c C `-FS— o�`F—lf JOB ADDRESS AND LOIA ION----`----00" 7. --- ` J `< SGL/---- 'r----------------------------- --- Owner's Name <�:---- ----------------------------- --------- Phone 75-17 rr�� Address,r5 d •. - --------------------------------- ------------------------------------------------------ --- ---------- - Contractor's Nae , - - t ' hone -- - - 7; Installation will save: Res end e❑ artmentLHo�e ❑ Commercial1❑ Trai Cou t ❑ Votl ❑ Other 0� Number of living units:a---T Number of bedrooms ______: Number ofi,baths . __ Lot ize -- �--__ _-_.__-______-___ Water Supply: Public system- Comrriun1ty system`❑ Private ❑ Depth to Water Table I ft. Character of soil to a depth of 3 feet:-' Sand ❑ Gravel ❑ Sandy Loa& Clay Loa!❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ NoV New Construction: Yes,VL No ❑ FHA/,VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICA ION5: ' Nore-fit+tank o'`r ess ool ermitted'if` u-6lic�seiWWis availeEile witliin,200 feet. ; Septic Tank: { Distance from nearesr wel Distance from�fou dation_ s ____.Ma �alC-0-h_Le"--e-__ ' ] No. of corn artments____ � ----- _ p ____-- - Size_ __Liquid depth- yj Capacity" . j , Disposal Field: Distance from nearest well_________ ______Distance from1foundafi6n_t___ Distance to nearest lot line__"---_.________ Type of fil eer of lr materia___ _ ----Depth off each line_' _" _j_ -`__-Width of trench_-___ r filter matelr�IR_Nj4P-----M----Total length______ Q_------------ - '_i Seepa Pit: Distance to nearest well__ �Li "g __-_Distant ro f un ati nL_PM--t.----Distanc to nearest lot line----- Number of pits-------------------- material ,Diameter---- ,3-_-_-: Depth-----�_*}� -----•--_-- Cesspool: Distance from nearest well-----------------D-Z e" o o "dation------------------- Lining material______-_--______-_____-_-___________- ❑ Size: Diameyer-------------------------,_------------Depth------------------------s'!------ --------- --._Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------__-----------------Distance from nearest building____________________________________--__. ❑ Distance toonearest lot line--------------__-__ f t--------------------------------------------------------------- Remodeling and/or repairing (describe):---------_----------------- -------------------------------------------------------------------------------------------------------------- - -------=-------------------------•------------------------ ------- ----------------------------------- -- ------------ -------------`--------------------------- = --------------------•----- ------------------------------------------------------------ . I ----------------------------=--- ----- - s ------------••----------•-------------------------------------------------•--------------•---------------------------------- I hereby certify that I have prepared this application and that the work will 6e done'in accordance with San Joaquin County ordinances, State laws, and s and r ns the a Local Health D' rict. (Signed) - - -------------------- --_Owne nd or Contractor Y __Title / sy:. (Title) -------------------- (Plot plan, showing size of I to ion of sys m n r tion to wills, uildings, etc., can be placed on'.,reverse side). ( OR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY-L=_.- -- —=— --------------------------------------- DATE-----'"------ -------------- REVIEWED BY -------------9 DATE {- /� BUILDING PERMIT ISSUED---__--------------- -�----- ------- ---------- ------------------------------------ DATE----- -----•--------------------------------------------- j Alterations and/or recommendations:__ ______._ i ----------------------------------------------------- ----------------------- ------------------------- --------------------------------------------------------•----------•------------••------------------•---------------------------------------- i ------------------------------------------------------- ------------------------------------------- ---------------------------------------- --------------------------------------------------------------------------------------------------------------•------------------------ IA.� FINAL INSPECTION -BY:---------/ = l ----------- Date------�/ --- ------ ----------------------------- 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 E5-4-2M , Revisea 1.57 F.P.CO.4� L ;