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0 Permit No. ___.7- ---- '17 -APPLICATION FOR SANITATION PERMIT (Complete in Dupicae) �0 �} Date Issued lt _----- ---� -�--� ` made to the San Joaquin Local Health District' for a permit to construct and install the work herein described. Application is hereby This application is made in compliance with County Ordinance No. 549. G .. ---- --------------- JOBate ADDRESS AND LOCATION-___ -_i4'__�jC --------- , t . Owner's Name-------- -------- - ------------ Phone `.- - .. ;. _._. - - - . Addresss , = '�?� ...__a ------------------------------- ---------------- Phone, Contractor's Name___-____--- _ s-_-- ---- -- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E]`Motel ❑ Other ❑ ---- Lot size ---/171 _x_ ` ------------------------•- Number of living-units: _______ Number of bedrooms _ ,_ of baths _� Water Supply: 'Public system pS• Community system ❑ Private ❑ Depth to Water Table -------- it. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 0�_ New Construction: Yes X No ❑ FHA/VA.. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ; . - .. '' // _ JJ ,�. - Material ��ipee,/ .-------........... Septic Tank: Distance from nearest well___1`OA&Distance from foundation__ ` No. of compartments_ Size-------------------------------Liquid depth---------6---k--- -----Capacity Q O --r---- --•- �. Disposal Field: Distance from. nearest well..../YfP FDistance from foundation_- -----,Distance to nearest lot line-J916____..__ Number of lines-------- __--. ------'-Length of each line---- -0 --!--- :Width of trench------- _£�--------------- Type of filter material____��-� '-Depth of filter material------ __.__�--fatal length___.___.-T-0---------------•-------•- i - - - _6_.__'Distanc1 to nearest lot Seepage Pit: Distance to nearest well_ - -!?� -----Distance from foundation___._ _ �j Number of pits------ s Linin mate rial---�d�I _.Size: Diameter=� _----------Depth---- -- ----------------- Cesspool; Distance from nearest well1_:_-________Destance from foundation_-_______-..1_-_>__lining material__-_____.___________________________ 1---.1-Liquid Ca Capacity..--------------------------gals. ❑ Size: Diameter---------=-----=-=---- ,.Depthp Y - I Distance from nearest yell------------------ Distance from nearest building------------------------------------------ Privy: if.� ---------------- ---- --------------- Distance to nearest iot'line-------- - -----'�"=--"'_...' -==---=`--------------------------J---I-•------•------- ----•-------- --------------- �� ` - "�" ----------------------------•---- Remodeling and/oi repairing (describe}:_ _____ ------------------- ~ .7 I ----------- = ; 1 41 r -------------------- --_ ---------- ------------------------=------------------------ ------------------------------------------------- ------�--: _ f ! ----------- --------------------------------------------------------=------------------------- I hereby certify that Fhave prepared this application and,that the work will be done in accordance with San Joaquin County ordinances, State law, and rules and tions of the San Joaquin Local Health District. -----------------------[Owner and/or Contractor] (Signed) - -- - ..... d - (Title)--------� --=------ --------- ----------------- BY= : _ --------- ----- -- ------------------- (Plot plan, showing size of tot, location of sys+em i lafion to wells, buildings, etc., can go placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- - ['DATE------- ATE- ------•---- --------�-�-------------------- -- -------------------- REVIEWEDBY------------------------------------------------------------ - ---------------------------------- • ._ - ----=------- DATE ----------------------------....... BUILDING PERMIT 1SSUED-----=-------------------------------- --------- -- - [ Alterations y,nd/or recommendations:_•------.-____.___-___ .__- ---- --- -- - td -- • -----------------------•------- -------- '7- r a __ I � �• = _73- - -- ALI% --- FINAL INSPECTION•BY: -- - ----- Date s= �- -------�--------------- ------------ SAN JOAQUIN41CAL HEALTH DISTRICT f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i E5-9-2M , Revised 1.57 FY CO.