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ZZ =%- APPLICATION FOR SANITATION PERMIT Permit No- _! __ ._____ (Complete in Duplica%) ----qq y Date Issued --------�/�_1. 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. JOB ADDRESS AND LOCATION------ --� ��f__------ -/ I�� Owner's Name---------- --------- -f.2 ° -d- —------------------------------------------------------------------- Phone------------------------------------ Address-•-------- ------------------- ------ ----- --------------------------------------------------------'/�-•------------/---------• 1 Contractor's Name -J'J------------- ' _/cS� x� Phone -WJE--- 0A1 '� Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ T Number of living units: --- umber of bedrooms -7,Number of baths __/_ Lot size _____. ---- --1 -_( ------------ ----- Water Supply: Public system`❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool pei'mitted if public sewer is available within 200 feet.) l /;epti ,T.K k..r Distance from nearest wel{-----------------Distance from foundation--------------------Material---------------.__.__________-_-_-_________---_ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity_-------------------- Disposal ------------------- Dis osal Field: Distance from nearest well-.-A/0��.Distance from foundation-_��_`_ Distance to nearest lot line_Z_.________ Number of lines-,A---- - Length of each line-----.�0-________ _____Width of trench.___ ________-______..___ i/ T e of filter ma,terial------ -Gl�_Depth of filter material--_-/�_____.__Total length___.____��__ _____________________ Distance to near f r f / p' Se pa e Pit; est well___ _ �.r_Distance from foundatian_� ____....Distan`f to nearest lot iine__�- ._____ Linin material____._ Size: Diameter____. - _De th_-_��_________________ Number of pits---�--�--- -- g rL1-�. -- - p Cesspool• Distance from nearest well________________Distance from foundation___________-_- Lining material__..____.__.______-___._____._______. �( ❑ Size: Diameter ----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gaIs. Privy: Distance from nearest well----_-------------------------------------------Distance from nearest building------------------------------------------ ----------------------------- ❑ Distance to nearest lot line---------------------------- --- ------------------------------------------------------------------------- Remodeling and/or repairing (describe:------- J------- --J- ------�'------------------------- -------------- ---------- ----- ------------4--------------- � ----------------- --------------------------- -------------••------------------------------------------------------------------ -------------�. --------� - __%--------------------------------------------------------------- ------------------------------------•------------------------------- ------------------------------------- ------------------------k----------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done iin accordance with San Joaquin County ordinances, State laws, and rules an eguiations San Joaquin Local Health District. '�- -------------------- .__ Owner and/or Contractor) (Signed)------------------------------------ --- -�---[�1--�----- ---- - m � �. (Title) ---------- Y•-------------_-_--------------------- ---------------------------- --- --- -- (Plot plan, showing size of lot, location of system in.relation to well ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---------------------------------------------------------- DATE-_ _' `S �� i REVIEWEDBY------------- --------------------------------------------------------------------------------------------------------------- DATE---•------------------------------------------------------- ` BUILDING PERMIT ISSUED--------------- ------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations: _: --T---------------------7� -------aa�T.�- ---------- �---------------- -- Sp> cr�or-j--------F P ---------------------------------------------------------------- I --------------------------•------------------_. -------------------------------------------------------------------------------------- -------------- -------------------------------------------- -------------------------- ------------------------- -------------------------------------------------------------------------------------------- ------ I FINAL INSPECTIO _- -`- -- - _ - _ Date-------S'_�� ------------------------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M . Revised ;-57 F.P.CO_