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{a�51 APPLICATION FOR SANITATION PERMIT Permit No. (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 with County Ordinance No. 549. f } M JOB ADDRESS AND LOCATION ` `Z� � �� '--------------------- 2 " "' f`G� ��09�__P RA Owner's NameJ!/S _ -------------•-------------------------=----- Phone : - - - Address ' '..... / ------------------ ------•------------•--=•----------- --^---------------�Q---- Name L .Jfrf = �" "� `�`}'�`�`E -------------•---- -- Ph ne - ----------------------- Contractor's --Y Installation will serve: Re si ante ®, Apartment House ❑ Commercial ❑ •Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,--_-f___ Number of bedrooms ---I... Number of baths ---.1--- Lot size _____��_ , '-- _________________________.___._ Water Supply: Public-system.' ❑ Commun'ity system ❑ ' Private [Z: Depth to Water Table _Yo-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa E7 Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: Yes ❑ No ©, New Construction: Yes,❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well__ __...__Distance from foundation_ e� ----------Material---- ,C '_---___.._.-_-----. ., ❑ V_ __ ?"__:_--Li Liquid de th__--__�_e-_-------_--No. of compartments__.._____ ----- -----Size Ca acit 1r�oo C, r p Y Disposal Field: Distance from nearest well_.<�........Distance from foundation----�_ -'-___.-_Distance to nearest lot line----z??'.�_.. t Q4 Number of lines-------------1--------------------Length of each line-------� 4_ Width of trench_ --o --�!--- •--------- Type of filter mate rial._._�a� �---------Depth of filter material---i ' "___._____._Total length__S'.r3_.f______________________________ Seepage Pit. Distance to nearest.well-----l�P_ ______.Distance from foundation_,S ----_-----Distance to nearest lot line_A _ ------ ❑ Number of pits------_-1-'----------Linvng material---_��...... ---Size: Diameter-_.__9_.m--------_.Depth ----------------- �,... Cesspool: Distance�froni-nearest weld----------------- from foundation-------------__-__.Lining material------------------------------------- ti F1 Size: Diameter------------------- ------------Depth---;----------------- --------------- --------- Liquid Capacity gals. Privy: Distance from nearest well------------------------------------------:......Distance from nearest building--------.-----_-.-_._.--._-_______._--_--- ❑ 'Distance to'nearest lot line_"- ==--------------------=-- ----------------- --------------------------------------------------------------------------- Remodeling and/or repairing (describe}-=-------------'- -------------------"-.-------------- -------------•---------------=------- ---------------------------------•--•-•---•--;------•--- r ; --------------•--'----- --------------------------------------------- �. ------------------------------------------------------------------=-=---------------------------------------- ------------------------------------------------------------ ------------------•-----------------•-•--------•------------------ 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 rule'sand regulations of.the San Joaquin Local Health District. " {Signed} i � - r -, ti!tr�r .- ------------------------------------- --(Owner and/or Contractor) By:-------------------------------------- <(1 ±Wit-_--- ------ (Title).._ , (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- ---------------------------------------- -------------------------------------------- DATE"3- ---------------- --------------------------------- «! REVIEWEDBY-----------------------'------- --------- ---------------------------------------------------------------------------------- DATE_ ----- I BUILDING PERMIT ISSUED = - ------------------------ DATE _ �f Alterationsand/or recommendations---------=--------------------------------------------------------------------------------------- -------------------------------------------------------------- -- ------------------------------------------------------------- ----------------------------- -----------------------------------------------=--------------------------------------------------------------------------------------------------------------------------•------------- ---------------------------------------> ------------------------------ -----------_--------------------------------------------------------.....------- -------------------------------------------------------------- iw � Date - V1 --------------------- '4 FINAL INSPECTION - ---=---------- - vY - --- �-BYSAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Califernis Manteca, California Tracy, California t=' . a ES-9-2M , Revisea 1-57 F.P,CO.