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'~ APPLICATION FOR SANITATION PERMIT Permit No. ._ ------ I�V/ C r (Complete in Duplicated Date Issued di. L' pplication is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ---- ------------------------------------------ JOB ADDRESS AND LOCATION---- -! �' ©gyp{ ----N_'--- �^ - - '�- �.,. - Owner's Name--------------------------------- _F1� V_-------- O�_U---------------------------------- Phone N�11'lr� � Address `� ----------------------------------------------------------------- ------------ ----[�-------- # -�-=------------ Phone----- - --- Contractor's Name----------------------_:IQ-�- } Installation will serve: Residence Apartment House F1Commercial E] Trailer Court ElMotel ❑ Other E] Number of living units: I___ Number of bedrooms I___ Number of baths __/--- Lot size � �x•�--��--r Water Supply: Public system Community system ❑ Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Ll Clay Loam E] Clay ❑ Adobe Hardpan El Previous Application Made: Yes ❑ Nox, New Construction: Yew No E] tV'\` TYPE OF INSTALLATION AND SPECIFICATIONS: `/ - WF (No septic tank or cesspool permitted if pu�lic sewer is available within 200 e Qt.) ----- Septic Tank: Distance from nearest wel0"_ ____Size_____Distance from foundation_ __ Material_____ _____�__-____---'! ----- Liquid depth__ -`- --------Capacity__ No. of compartments___._ --� �- - - --------- - ----- - - ---- - . y - Disposal Field: Distance from nearest well _______________.Distance from foundation---------------------Distance to nearest lot line----------------- DNumber of lines-----------------------------------Length of each line-----------------_-----------.Width of french-------------------------------- Type of filter material-------------------------Depth of filter material---------------- --Total length------------------------------------------ Seepa e Pit: Distance to nearest well_ --Distance from foundation-----*ti}_----------Distance to nearest lot line___..________ I Number of pits--------I-------------Lining material 6644 -Size: Diamete r____J_c `_-'______.Depth---A.Z-'o------------------ � ________Distance from foundation_________._.___.___.Lining material------------------------------------- e`s�pool: Distance from nearest well_________ gals. 1 ❑ Size: Diameter-------------------------------------Depth__------------------------ = Liquid Capacity Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------_--------------------- Remodeling and/or repairing (describe)------------------------------- - -------•--------------------------------------------------- --------------- ------------------------------------------------------------------------------------- ------------------_---------------------------•------------------------------------------------------•-----•----------------------------------------------------------------------------------------------------------- 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 of the San Joaquin Local Health District. t f_I_�r _ �'"-.----- -------------------- Owner and/or Contractor) (Signed)--- - -�=} _A-r_t"-'---- --------- - ---- ------------- - ( / (Plot plan(-showing size of lot, location ofOystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ ARPLICATION ACCEPTED BY_____________ ___ ___ _____ _____ ------------- DATE - --- ---1-�--- ~ REVIEWED BY------------------------------ - ---- ----------------- DATE---------- --------�-------------------------------- -- ------- - ----------- ---- -- - -------- ------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ -------------------------------------- --------------------------------------------- DATE----------1------------------------------------------------ r Alterations and/or recommendations--------------- ---- -------------------------------------------------------------------------------- ------- ------------------ ----------- -----------------------=--- Date-.- - "J FINAL INSPECTION BY---------------------------------------------- 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 ES-9-2M B-51 Revised W-2100