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1�Y APPLICATION FOR SANITATION PERMIT Permit No. ---- __3o __ (Complete in Duplicate) -1 Date Issued A Thipplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_!.___ Owner's Name - -z-� ------------------------ --------- -- Phone_ - -fwl-.•t_ec�_' ��"L. Address---------Z1 Z19-PA-1 ---- - --------------------------------------- Contractor's Name--------•-----•-------- (1_44. .a.� Phone _. - ----- -- - ------------------------------- A..__ A Installation will serve: Residence EKAparfment House fl Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _'I< Number of baths ---_____ Lot size Water Supply: Public system 2__*`&ommunity system ❑ Private ❑ Depth to Water Table Jr ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E],—Hardpan ❑ Previous Application Mader Yes �No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer_ is available within 200 feet.) - ic Distance from nearest well-----------------Distance from foundation--------.-----------Material_ :X- No. of compartments--------------------- ----Size-------------------- -------Liquid depth.------------- - - - ---- -----Capacity------------ --------- D' osa FZeld: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line__ _ Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------_-_-__--_-.-.-_-_-_-__--- __ Type of filter material---------------:------ -Depth of filter material---------------------._Total length------------------•--------------------. Pit Distance to"nearest welt_y■1A-A140_____---Distanc rom foundation_��' ---_-•--..Distance to nearest lot line----/_-a-.-_-__Number of pits._..__!______________Lining material_ _ Size: Diameter_ --t_ .tipa;9! - -- z Deptn_. _,jM N� -- -- ------------------ Cesspool• Distance frorri nearest well---.--- Distance from foundation._.----_________.__ Lining material_ ..___._____.____.__-___._ ._ ----- \ ❑ Size: Diameter...-i---- -- ------------- --- T' Depth---- -----------------------_- - - ---------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----.------- ---------------------------_..___._Distance from nearest line - .^ building❑ Distance to nearestlot ------ . ------------ Qf 4M -------------------- --------------- -- ---------------------------------------------- Remodeling and/or repairing (describe): f -------------------------------------•-------••-----•---••-----•----- -----------------------•--------------- ----------- ------------------ i ------------------------------------------------------------------------------------- ----------- --------••-----------------------------------•---- -- ------------•-------------- p p --- ---•-- ---- - - •- ---- -- ----------- - ---- -- - q -- .-Y I hereby certify that I have ' Y y pre ared this application and that the work will be done in accordance with San Joaquin Count ordinances4r alaws, and rules and regulations of the San Joaquin Local Health District. r (Signed)------ - �'-�'-r . )Z ' ' p^ri'S------ [ By:.......... ------- ---- - . -------------------------------------------------- � Contract ' -- ---.._Title--- or) (Plo+ plan, showing size of lot, location of system in relatio o wells, build,' s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----_-- - REVIEWED BY- ----- DATE-- ----------------------------- �` ---- -------•----------- --------------- ------------ DATE------ BUILDING PERMIT ISSUED �----------------------------------- ------•---------- •--------------------------------- t---- DATE------------- �-------------•------------- Alterations and/or recommendstions________________________ -----•---------------------------------------------------- ----------- ------------------------11-----•-----I--------- ----------- ---------------------- ---------------------- f•-----------------------------•------------------ ------ ------------------------------- ------ ----------•-•- FINAL INSPECTION BY................... 1 ] — Z- �� --------•--------------------- 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, CaliforniaTracy, California ES--9-2M 145446 gTw000 ,y-5p