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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ribed. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein desc This application is made in compliance with County Ordinance No. 549. W4 � 1-_;' ?0 ----------- ------------------------- ----------------------------------------- --------------------------------------------------------------- ---------- - JOB ADDRESS AQ 0ATION----------------- ) ----------- - ------- Phone__V- ----o-----_-_-�----_ 6-- - --- -----q..-.--.--.--4.--. Owner's Name- -------- ---------- - --------- -- - - Address. -Address--------- one----------------------------------- -- -- - - Ph z ------------ -------- - Contractor's Name--------C?V6_t4 - ; Installation will serve: Residence Apartment Hou5e 0Commercial C Trailer Court ❑ Motel [ Other C m' h A Lot size ------ ------------------ ro, Number of living units: -A--- Number of bedrooms __Number bat 's Private Depth to Wai�eri_TaUe%52—ft. Water Supply: Public system M Commur�ty system 11 Hardpan 0 1 11 a;�O 'V'� Cl Loam C]'Clay 0 Adobe'3 et' Sand Gra el [] Sandy Loam [�3 ! aY Character of soil.to a depth Of i .fe 0 No M ew Construction: Yes b.(No�E] FHA/VA� Yes Previous Application Made: Yes [I TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic +2 ink or'cesspool permitted if public-sewer is available within 200 feet.)t. Material_"- earest well- Disfancejfromfioun�ation-----V-0------- ------------- SepCa aat tic .Distance from n ----- Liquid dePth--- ------- ------ /Tank: No. of com 'ar ' ents-------2___ - ------; p ------(-Size---I- Distance to nearest lot line_.__-- from nearest well-_-._ ----Distance from founda io ----I---- Width of trench ------- -'Di; Field. t Length of each line -ka-l-V---------- trench.. -------------- Number of lines--- -------- L ------- ---- ------------------------- - �Depfh of filter materia�-----112.............Total length 7"1 Type of filter material___._ well----------------- ----Distance from foundation--------------------Distance to nearest lot line_.._--"-__-----._ I " v Seepage ine----------------- Seepage Pit: Distance to nearest �maf,�ri'@_=___.'Sizj: Diameter-----------------------Depth--------------------------------- Number of pits-----------------------Lining e fr m foundation.-__---------------Lining material------------------------------------- Distance fr6m nearest weil-----------------Distanc Cesspool'. 11 h ---- --------Liquid Capacity--------------------r-------gals. Size: Diameter,-------------------------------------Dept ----------------------------------- El I : stance from nearest building______________.----.__-""-------------- Privy- Distance from.,nearest well------------------------------- f--------I_-._Distance-------------------------- --------------------------------------------------------- ❑ Distance to nearest lot line--------- ---------------------- -------- --------------- -------------------------------------- I Remodeling --o--r----r-e--p--a--i-r-i-n--g-- (describe - - ----I---=------- ----------------------------------------------------------------------------- 1 -------------------- - ---------- --------------------------------- --------------------------------- ------------ - ---------- ----- ------- --------------I--------------------------------- --------------- ----------------------------------------------------- .1 - --------I--------I------------------------------------ --------------------I--------------------------------------- - ------------------------ �y that 1 have�`prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify ns of the San Joaquin Local Health District. ordinances, State laws, and ruled and regulatio (Owner and/or Contractor] (Signed)..7k ---------------------------------------------------------------------------------------------- ---------- ------------------------------ ---------3 (Title)--------------------- ----------------------------------------------- BY:_---------------- - -- wells, buildings, etc. can be placed on reverse side). (Plot plan, showing size of lot, location of sy�sfern in relation to ; FOR DEPARTMENT USE ONLY DATE------ A- -------- ------------------- ----------------------------------- 1 7 - --------------------- APPLICATION ACCEPTED BY------------------ ---- - - -------- ------ -------- DATE---:-- --------------------------- --------------------- REVIEWEDBY-------------=----------------- ----------------- -- ------ - - ------------------- BUILDINGPERMIT ISSUED----- --------_-------------- --------------------------------------------------------------------- DATE__--------- Alterations and/or recommendations---------------- -------------------------------------------------------------------- ------------------------------------------- --------------------------------------------------------------- ------------------------------------------------ - ------------ ------------- t ----------I------------------- ---------------- --------------------------------------------------------- ----------------------------------- ----- ------------------------------------------------------------------------------------------------------- -------------------------------------------I----------------------- ---------------------------------------------------------------------------------------------------------------------------- ------------------------------ f , ----------1- [ --- --- ------- --- ------- I 4ft/ Date_------ ------- -- --- ----- --I------------- FINAL INSPECTION BY:----------------- ------------------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street $14 North "C" Street TracyCalifornia , 130 South American Street Manteca, Cali Stockton, California Lod;, California ES-9-2M - Revised 1.57 F,P CO.