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��ry1 APPLICATION FOR SANITATION PERMIT Permit No.:°----__... 1�t1n (Complete in Duplicate) P P � _ 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. }} JOB ADDRESS AND LOCATION--------- ---- 2-19- 0-7----t ---------------- & ------------------ ------------------------------------------------------ Owners Name------ ..... - . --- --------- --------------------- r.,. M - Address ' '� }--- - --------------- ---------- --- = ----- - - ---- - �. r c Contractor's Name------- tteal ..... PhoneAt Installation will serve: � Residen a [ Apartme House ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ © t Number of living units: ---I---- Number cf bedrooms .__°,�_ Number of baths __j... Lot size ___.. _ ___�_ _ -------------------------- Number Supply: Publics stem Commun`it system r 'Private -'Depth to Water Table *&- ft. ""� PP Y� Y Cl�,::T • t Y Y ❑� 0 _. P i Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No E] New Construction: Yes ❑ No ❑ FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------------`Distance from foundation---_---.____-------.Materiai_-__._--:-----_.__--_----------."_._......_...._. ' El No. of compartments--------------------------Size-----------------------------__Liquid depth--------------------------Capacity ------'_ ---- Disposal �---- Field: Distance from nearest well._-Distance from foundation____.31Q__1--_--Distance to nearest lot line--.�--._--.. Length of each line___._____1 4� �✓ Width of +ranch_________ _ ___I-i____._._. '_Number of lines g (� ;, �p Type of filter material___._ - - --- -_Depth of filter material------�_97___-_--.Total length.'....._.._�_e----__-_-:-_-_-..--_- :. .. _ Seepage pit:' Distance to.nearest well_.1! ____Distance from, undation T' �. ----.Distance'to nearest lot fine__ �.__.__ Numbercf pits---------:I----------Lining material--- Size: D.iameter___-•_.�---�-____-.Depth-----��``.-____.�----- ---� --- Cesspool: ' - Distance from nearest.,well------ Distance from-foundation.__............:...Lining material-------------------------- ...----_--. ❑ Size: Diameter----------------------------------------:Depth_------==------------------------------------------Liquid Capacity- -------------------------- Privy: -------------------- ---Privy: :Distance fr m near`est'well-------------------------------------------------Distance from nearest building----_-___----.________________--.------ v -i-Distance to'nearest lot line.:- �= � = �.._., .- ❑ ------------------------------- deling and/or repairing [describe) - '= `--`------=----------------'=--=-----•--------•- ----------------------------- Remo ` ' -------------------------=--•-----------------------•--------------•---------- ------------------------------------- --- ` + ------ ----------------------- ------------- ---------------- -=------------------• ---•-----------------------------------------------=-----------------------` --------------------------------------- ---------- ----------- ----- -- I hereby certify that,I have.prepared this application and that the work will be done',in accordance with San Joaquin County ordinances, State l ws, and rules and regulations of the Saran Joaquin Local Health istrict. 4- dI'll - �" --------- (Signep (Owner and/or Contractor) - r ,.. --(Title)-- . (Plot plan, showing size of'lot, location of system in,relation to wells, buildings, etc., can be placed on on side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------r---------- -------- ----------;-------------------------- DATE----- -------------------------- ---------------------------- . REVIEWED BY-------------------------- --- ------ -- ' DATE BUILDING PERMIT ISSUED = ------------------ DATE ---------------t Alterations ------ - Alterations and/or recommendations:------------------- _ � '•• t ---------------------- T ,. _ -------- ---- r r --- __ •--- ----_.-_ ----------------------------------------- - ---•-------------------•--------------------- ---------------------------- -------- - -------------------r-1 ---------------------------------------------------------------- i f - r li Date FINAL-INSPECTION BY:_-_: :�t!'r �:. - _ .-• -------------------- -. 111 SAN JOAQUIN 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 E5-9-2M , Revisep 1-57 FY,CO.