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APPLICATION FOR SANITATION PERMIT Permit No. 1-d ?......... �-- (Complete in Duplicate) �L.. bate 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, `3 97 S "rte I C-•f f BAJA �1 j * j-7 4—f-71— 03 JOS-ADDRESS AND LO�ATION ---Z-144'2j - ----- -----------------�-----��------------------------------------.------------------------- Owner's.Name --------------------------------- �G ---------------- Phone---------- ------------ -•---------- _ . .. ..� � -----.-�- -�--.------a--i-r ---------------�r r. - Address---------------------------------------------------------------------------•-------------------------------_------------------------------------- --------------- ---- L �(��'9 T• SL- /lU� ---- ,Fr Phone:. _. �``I___E{-?.7 Contractor's Name----- ____r__._..t__-- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer ourt ❑ Motel ❑ Other ❑ 'f Number of living units: —Number of bedrooms _" _ Number of baths ---/--- Lot siie ---------- 0_ _.j sd_____________________ Water Supply: Public system E] Community system ❑ Private Depth to Water Table ________'ft" Character of soil to a depth of 3 feet:: Sand ❑ Gravel,❑ Sandy,Loam E] Clay Loam E] . Clay E] Adobe Hardpan 0 Previous Application Made: Yes ❑ No �% New Construction `Yes No ❑ FHA/VA: Yes [-] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '""' f,. �1 (Nofseptic tank or'cesspool permitted if public sewer is available within 200 feet.) ' , Septic Tank: Distance from nearest we,l.l___-d______bistance rom founds ion___: _.__ Maters I-------.-._.___-__ _ ____ ___ _ W ; �- -----------Size---- J Liquid depth-- ----- Capacity------ � No. of compartments______ At Disposal Field: Distance from nearest well_ Distance from foun6ation----Id_-____Distance to nearest lot line__-_i f' � Number of lines___________ ------- -Length of each line------ - -------------Width of trench.____.______�4-_ ______Qp Type of filter material-_ P .....ODepth"of'filter material___-____.L _____7otal length_____________ ______.-_..._f__, Seepage Pit: Distance to nearest well________________ ____ Distance from foundation--------------------LDisfance to nearest lot line------_•____.-_✓? ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------------------Depth---------------------------------- s Cesspool: Distance from nearest well----------------- from foundation____________________Lining material____-_______-_...__.______._______,, ❑ Size: Diameter------ =------------------- ----- --.Depth----------------------------------------------------Liquid Capacity---------------- -----------g Privy: # Distance from nearest well________________________________________ '_Distance from nearest building--_---_-..-_.__________.____ __ . ❑ Distance to nearest lot line---- --- ----- t. ------------•-------------------------------------- Re bdelin and or re ai in describe :_Q-� _ -- ✓ - ?L� i 9 /. P JJ' 9 I } t �y � �._ �Cct�✓ _Gl�t �,t° - '`r j, -------•-- 1. -------•• �"-- -- ti �- -- :...-•--------------------------- _________________________________-j_--------------------------------------------------------------------------------------------------------------------------------------------....____.._-_-__________.__._-____.__.��_{{��\ I hereby certify that I have prepared Ais'ap"plicati n and'that fhb-York will be done in accordance with San JoaquinCaunfy ordinances, S e i ,,an rules,and regofguulatio he San Joa i Local He.-a'lth District. + - Owner and/or Contractor (Signed)- : E = ---------------- ( / ) By:--------------------------------------------- -------'------=----------------------- ---------------------------------------------(Title)---------------------------------------------------------------- (Plot ---------- ---------------------__=----•-_(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in-relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•-----_-- t D E '- - REVIEWED BY.---- y �----ti-------------------- --- DATE -- BUILDINGPERMIT ISSUED----------------------------------------------------------------------=------------------------------ DATE------------------------------------------------------------ Alterations and/or re commendations:-------------- --------------------------- ---------------------------- - = ------------------- - i� f,t t°' V _ _ - -------------------------------- - ---- --- - ----- FINAL INSPECTION ,-BY-.- -------------- ------------ -- ---------- Date_- "---------------::---- ------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oek Street 132 Sycamore Street 814 North "C" Sfreaf Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 EP.CO_