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- ° �.- a APPLICATION FOR SANITATION PERMIT Permit No. __,c2lG_ _____ �6 (Complete in Duplicate) Date Issued Z.-//� i -------------L_---_ _ 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 Nom. ,5„49. !i �r JOB ADDRESS AND LOCATION = VF�. R -----------------------t------------ f Owner's Name -��++e.- dY ---------- --------------------------------- Phone, &__ ;;' ---------------- -- AddressIhI - --------•L d i .�i ••---•••--------------• -----------__-------------------------------------- Contractor's Name__= --------- Installation --- Installa+ion will serve: Residence CK Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - Number of baths Ems. I Number of bedrooms _ g -•- -- Lot size __-��-•�'e-- -------------�c�.C�,-�'------- Water Supply: Public system ❑ Community system ❑' Private D(" Depth to Water Table 30 ft. Character of soil to a depth of 3 feet: Sand' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: Yes ❑ ;No ;S, New Construction: Yes VQ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if'public sewer is available within 200 fee+.) Septic Tank: Distance from nearest welL_,,$-'O-------Distance from foundation----lS1---------Material........RR-/G/�__-----_ IX No, of compartments-------�----------:Size-------6t "--------------Liquid depth--- `��-rapacity----/��Wrs Disposal Field: Distance from nearest well.--_11----Distance from foundation-_1'[ f_`____.--Distance to nearest lot line---AIel�� I Number of,lines-_t-_ ?40 -Width of trench � - �---- -- ----------Length of each line--____-- - _ pis !a Type of filter mater:al___.__�_ _0jC/�:-___Depth of filter material___ _-;,_____Total length______{ -- ___•__________- /. � t Seepa e Pit: Distance to nearest well_____________________Distance from foundation_____'_____________:Distance to nearest lot line________- Number of pits---I-----------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation_____'F___________-_.Lining material__--__________--____----________.____. Size: Diameter- 1 ---------------------------Depth----- -------------------------- -=-------------Liquid Capacity----------------------------gals. \ Privy: Distance from nearest well--------------------------------------------------Distance from nearest buiiding------------------------------------------ Distance to nearest lot line-..------------ == = = Remodeling, - and/or fepeiring (describe): r '''� ------=------------------------------------ , `"- + �s ,, c 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 law and rules and re ula+ions of the San Joaquin Local Health District. r (Signed)------ --- --- 4 ----------------------(Owner and/or Contractor) gY� ----------------------- -(Title) --------------- (Plot plan, showing size of lot, location o stem in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l - - --------------------------------------------- -------------- Q DATE__ -----_---- ln_--- REVIEWED BY ----------------------------•------------- ----- DATE__7• '---------- --------•----------'- '---------- BUILDING PERMIT ISSUED_.:..- --------------------------------------------- DATE--------�------- Alterations and/or recommendations:.------- --------------------- -----------------------------------------------------------(S ------ o- f --------- ---------------•-----------•---------•---------------------- -------------------•-------- ---- --------------------------------------- -----------•--••-------------------------------------------------------------------------------- ------------------------------------------------- ---------•-----------'---------------------------------------------------------- ------------ --------- ----------------------------------------------------- --------------•---------------- -------------•••---------•---•------------------ •-------------------------------------------- Y *J FINAL INSPECTION BY:- ! =- T Date -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California i Tracy, California i E5--9-2M • Revised 1.57 FY.CO. ��' `