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\ Permit No.APPLICATION FOR SANITATION PERMIT - 6 • � ,A''( (Complete in Duplicate) 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 wit)hGCJounty Ordinance No. 549. l JOB ADDRESS ND�LO N ATI --- t f"-------- --- ----- --- ----' "�` - --__--------------- Owner's Name-- _ ----- Phone.-._. ; Address - zq f vt�tet; �- Contractor's Name __ i.h _`r!w �!_ fl, .. Phone Installation will serve: Residence Apartment House Commercie ❑ railer Court ❑ Motel ❑ Other ❑ Number of living units: -�_::_ Number of bedrooms -&- Number of baths =_1____ Lot size _________________ fJ Water Supply: Public system[] Community system❑ Private � pth tof z Water Table ----------ft. Character of soil to a depth of 3 feet: Sand 0� Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ obe �- Hrdpan Ad ❑ Previous Application Made: Yes ❑ No 5?r New Construction: Yes g No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: p (No septic tank or'cesspool permitted if pubic sewer is available within 200 feet.) ' �. i Septic "ank: Distance from nearest we'll 0_ ta-ce from foundation".`y, ________.___ aerial___cli_ _______________ �cR"� J No'No. of compartments'-- r.__. r- Si, . depth-_- - ..----_---Capacity-LL_Q- --'- f!' Dis osa Field: Distance from nearest'we4076 ' -Distance from foundafion�p_ Distance to nearest lot lin ��'�a p y t ------ ' Number of lines----------- _._--___-----Length of each line----------____0_ Width of trench-_-______. ________ T pe'of filter'm _ /Y@�'�'�Depth of filter material_-_�_--_____________Total length______._ _ _ 1 Ty r �r y Seepage Pit: Distanceto nearest-well_________________w__Distance from foundation_____"_._:_'____..Distance to nearest lot line _____.._._.___.._ r ❑ Numb"er sof pits.f-------------------Lining material----------.------------size: Diameter------------------------Depth---------.----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material______________________________________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. • Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El --------_--------------------------- ---'❑ Distance,to:nearesf lonline'n----=---------------------------- -----------------------------------------------•-----=--------•---------------------------------------- I Remodeling and/or repairing (describe):------------------------ ----------------------------------------•----------------------------•----------- ----------------- ------- 1 5 ' --------------------------------------_____.--________-_..-_____________...__-____-____________________ ------_---------------------------.----------------------------------------------------- 3 - ------------------------------------------------------------------------------------- __ _ _ __ ____________________ _________________________________________________________________________________ I 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. Signed9ned)-- (Owner and/or Contractors BY. -------------------------------------------'--------------------------------------------(Title)------------------------------------------ --------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ ---------------------------- i DATE---,----- ! ` DATE---._ 5r ---------------------•-------------------- REVIEWED BY------------------------------ ----- ----------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED_--`-------------------------------------------------------------------------------------------------- DATE------ ------------------------------------------------ Iterations -------------------------------•---- •-------Iterations and/or ecommend ratLio'ns:_-___1-:__!-_I__.____l__�.._#_�__;_ _ ----`------ - ` L/„r-p<az . ---------"-----------------------------------•-`------------------------------------------------------------------------- ..� h.•r. .l1. ---------------------------------------------------------I----------------- � ------------- ----------------•-----------------------------------------------•------------------------------- --=-------------------------------------------------------------- -------------------------- ----------------- J FINAL INSPECTION BY: � - -- --------- I ---------I-'-1.------ -- Date.--- --- --- --------------------------•------------------------ SAN JN 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 Revisea 1.57 F.P.CO.