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APPLICATION FOR SANITATION PERMIT Permit'No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From m Date Issued 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. jN�D�f L"OCA�TIO�__JOB ADDRESS ------ Owner's --- - Owner's Name------- /G/Sr� Lfl1___-_--.-_----- �--------------------- --'`�'-'---------- --y----------- ------- Phone -f---�--1----"-"-�--•s--------_-_- •--------..._ � Address---------- ------------------------------- -=------------------------- G g �- 4-- Contractor's Name------ '�l F 4= --- -------------------------- --------------------------------------- 4!---------- one - Ph -- :Zt�f Installation will serve: Residence ❑ 'Apartment House [:1 Commercial Trailer Court ❑ Motel ❑ Other F1 Number of living units: _ __ Number of bedrooms ._/-. Number of baths ----A---- Lot size -fes1'G ---------------------------- i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -YA ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 'Hardpan ❑ Previous Application Made: Yes ❑ No RT- New Construction: Yes ❑ No Y�r'FFiA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.Tank: Distance from. nearest well_________________Distance from foundation--------------------Material _---_.._--_-_.__-.------------------------------ P ---------------,------- tryr05rM.! No. of compartments--------------------------Size-----..-------------------------Liquid depth--------------------------Ca Capacity Disppsal Fuld: Distance from nearest well_________________Distance from foundation-/Q__:t77:-----Distance to nearest lot h�e.. x�' Number of lines-----�,.�------------------------Length of each line_ ?�_'7�p-i ---Width of trench---- 0___- ------------- Type of filter material-�AG.)'--—Depth-of filter material_-__�__O_i__- ----Total length___._--____/ _______________________ s Seepag Pit- Distance to neare �_ -f3.is#ante fr m foundati'� r�� -�D+ tante to nearest lot line_ s IL - !�f Number of pits +ng materia---- --- '--- - ---- lam - "spilt- CesSpo___888i1: [f Distance from nearest well----------- Distance from foundation___________________Lining material____��;-________-..___-_--________- �c -----DePfh=------- --------------------------- -------------Li Liquid Ca aci ----- L1 k gals. �} ❑ Size: Diameter q p ty..:: �1 i Privy: Distance from nearest well_-_____._._____--______._____R`-------------Distance from nearest-bui.lding._-- -.____-___._-__-__._____.----------. .11 ❑ to nearest.lot line------------------------ ---------- ------------------------------------------ Distance i - --= S +z �j � Remodeling and/or repairing (describe):------------- _ - ---- ' 1► ` Pi_�-�- .f �ti x- ------------- --------------------L� = P �. .a _ - " . a _ F• 1--�_______________________________�_____- _-__----.__-___-:'_...__,-__.._____.._..--,-_-------- . I hereby certify that I have prepared this application andce•that the work will be done in accordance wi , . tli San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ ------------(Qor Con+rector) Signed /�' � -------- ., -------------------------- By:------------------- -------------------------.._ '---------------------------------(rt / /' ------ --- ---- ---- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------- ---- -- ------------ -------------------- ------------- DATE----------- REVIEWED BY-------------------------- - --------- DATE BUILDING PERMIT ISSUED - DATE Alterations and/or recommendations:------ --- ------------ - ------------- ------•-------•---------------------•------------------------------------- i ------------------------- --------------'-------------------------------•--•• ---------------------------------- ------- FINAL INSP - ------ ---------- - ------ - - Date---- -- ---------- ---------- ----------------------- SAN JOAQUIN LOCAL�HtEALTH DISTRICTS . 130 South American Street 300 West Qak Street , 132`Sycamore Street y 814 North "C" Street . k Stockton. California Lodi, California Manteca, California Tracy, California t ES-9--2M REvised 8-'S9 F.P.Co.