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A (� APPLICATION FOR SANITATION PERMIT Permi�o. ' -e (Complete in Duplicate) / Il bate lssuec! :."-/-------------•--- 17 t 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. JOB ADDRESS AND LOCATION-------/r 9$1---------kV, 11, G��. .�_2------ ------------------------------------ ' �' �oRl_fi�/ d "' ------- Phone_ �__l�_ ------- Owner's Name--------- - --�Lp ----•--•- ----_---- - --- Address--------------�� JV-c----=-- /EE ! =.__. � �� ---------------------------------••---- --------...------- ------- ---- ,; � •' �►}'- ,�• Contractor's Name--•--=---- z- t--_-- --- l_.� ''-"'b`::5'1In -_. !Z— ------ Phone7��-- Installation will serve: {Residence E] Apac me4- ouse ❑-�Commercial.`K,�Traile�dCTourt ❑ Motel [:] Other ❑ + �E+ Number of living units: :__.____ Number of bedrooms «---.__ Number of baths- Lot size ___________--------------------_---------------------------- Water Supply: Public ,system` Community-system�❑' Pyr ate ❑ 'Depth to Water Table i� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Q Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobev Hardpan ❑ Previous Application Made: Yes ❑ No 5 New Constucticn:- Yes ❑ No .FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or'cesspool permw itted if public seer is available wifhin.200'feet.s F I� p . e nk: Distance from nearest well_________________Distance from foundation-____�,____________.Material_____.._-._--____..______.______-_____.________. ❑ No, of compartmerifis------.-. Size - x="`_.:� Liquid depth Capacity - Disposal Field: Distance from nearest--well../.tJ(N /000.�Distance from,foundation__x-.,2_4---------Distance to nearest lot line___` -.-....- E Number of lines_--:_°--V---------------------- -Length of each line----49.0'_.__________.Width of trench----�2_9.....------------____ Type of filter m' 'i of filter material_._.____-__--_ Total length-__---_______._-___-____________ ______- YP = r r � , i Seepage Pit: Distance to nearest.well___ - 15 _-_Distance om founcJation__jz Distance to nearest lot line__________-. ;I Number of pits___._�_*.___':_-Lining rriaterial__ o lC__.Size: Diameter_-��-------------Depth------- �_------------------ Cesspool: ---_____________ P ,. ! 1 ----r Depth ' � _ � Cess ool: from nearest well Distance from foundation_...___ Lining material-------------------------------------- Distance fs \ ❑ Size. Diameter - ----- s P e - Liquid Capacity 9 \ _v - . 4 Privy: Distance frori-n mare t vrell__x__�T -�--t`_.---------------��.---:Distance frommearesf ____________________________'_----.----. ❑ -- Disfance-to nearest lot line ' r .._� _j -.• r- Y t IRlem-o-deling and/o� 'r'e repairing (describes: , f ---------- ---- ------- --- ---- -------- -----•----------- ----- . -------------------------- -- -------- ----------------------- ------------------- -Rr ---- ---------- I-hereby certify fhaf I have •- eApaied this a plication and that the work will-be-done'in actor ` l� dance with San Joaquin County ordinances, State laws; and rul rd r gulati o t e an Joaquin Local Health District. t 40 s ------- -- -------------------- (Owner and/or Contractors (Signed)--------------------- ----- -- # Ei sY= - - .- .. ---- - - ---- = (Title) ------------ (Plot plan, showing size of lot, location of system in relation to wel uildings, etc., can be placed on reverse side). ' r FOR DEPARTMENT USE ONLY { ' - ------------------I------ DATE------� APPLICATION ACCEPTED BY ------------ ------- 'REVIEWED BY------------------------ ''' ------------ DATE------- "" }--------------------------------------- - - ----------------------------------- --- Vve BUILDING PERMIT' ISSUED----------= --- ---- '�' - DATE.-- ------ -- ,Alterations and/or recommendations: ---- - - ------------------------------ •-------------- ------ - -- - -- - - ------- _._-._________.__-_.______._ -___ ______---_.-__________.__________-_._-___.._____..______________...-- _ + ` ----------------- 4! _ N ;I FINAL INSPECTION' BY: == = Date ------------------------------------ ---------- ii SAN JOAQUIN LOCAL HEALTH DISTRICT 0 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street g Stockton, California Lodi, California Manteca, California Tracy, California IS E5 9---21x1 Revised 1.57 F_P.CO.