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x t APPLICATION FOR SANITATION PERMIT Permit No. ___-lQ3/ (Complete in Duplicate) � rr Date Issued __S_��__ Application is hereby made to the San Joaquin Loca! 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------------0�Q ---- ,----_L`i-_ r(? --!C ------------------------- ------------------------------------------------------------- Owner's Name----------- ls--------- t .` r-�-•PG' /i�- �-------------------------- ------ ------------------------------------ Phone_ /,O_��Yld---- Address--------------C21-v--t---------40, Contractor's Name-----------LO-WWO-14f------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence t�/ Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__- Number of bedrooms ---Z_ Number of baths ----L Lot size ------&7x---/ -------------------------- Water Supply: Public system 2"' 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 ❑ Nod 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---.-_--_______--__-------------_-_-_---.----. ❑ No. of compartments-------.�-v Si e-------------------------------Liquid depth------------------------ -Capacity-----------------:----- C-A Disposal Field: Distance from nearest well------ Distance from foundatior�,__Zf __Distance to nearest lot Ijpe-- ----------- P1 Number of lines---_______� .i--.-_-_--._ Length of each line------ Width of trench.__ --- Type of filter materia «- ifflepth of filter material__--------------Total length---- "----.' ©----___-i.__-- -seeperju--Nf: Distance to nearest well' -__Distance frc?foundation__l�-_--'�_.-_.Dist nce ttnearest lot line----�--_'-- Number of Pits------4------------Lining material --, . -4i_----Size: Diameter. ,x -`Depth-------6---------------------- t Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____---_---_---.---_.____-_-_-_---. 0 ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity----------------- ----------gals. C-1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------_-.-----_-__-__------------------. ❑ Distance to nearest lot line------ --------------------------------------------------------------- Remodelingand/or repairing (describe):------ ---------------------------------------------------------- ------------------------------•---------------------------------------------------- ---------------------------f �_ 6------� `T'm'" � !��' rJ'` �`f � ' .1��4 _ _'_ t r�e�Ct -. --- ----s '<------------------------------------------------------------------ ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5t fe laws, a rules and regulations of the San Joaquin Local Health District. (Signed)-- - 1 ' r4 - ------------------------ ------------------------------------------------------------ -----(Owner and/or Contractor] By:---------------------------------------------------------------------------- ------------------------------------------------------(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 BYDATE-------------- REVIEWEDBY------------------------------------------ -------- ------ ---------------------------------------------• DATE ------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE- Alterations and/or recommendations:---------------------------_---__-__ -_-_------____________-----_---- ----__ - : ,z-. -------- 1� -0& c > ` x -C 1 4�CGz-f _ FINAL INSPECTION BY: --------------------------- ----------- bates: 'S --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American $free+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.P.CO.