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APPLICATION FOR SANITATION PERMIT, (Complete in Duplicate) / Date Issued .✓ (_ }O Applicakion is hereby made to the San Joaquin Local Health District for 6 permit to construct and install the work hereirij&c ►d This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ ,---L0-y' °j ---------- h�4-I1 j_ `��'? ----------- Owner's Names j f �••---"---------------------------------------------------------- ---------------- Phone-----------•------------------------ Address-- - f f' Contractor's Name---C.11.ir r a�__CG►_ � ►i�q GV Phone -Ap_4-~710 Installation will serve: Residersce ❑ ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 21 Number of living units: -`-_ Number of.bedrooms . Number,of baths 7=7-. Lot size --- --------------------------- Water Supply: Public system D, -Community system ❑ Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeN, Hardpan ❑ Previous Application Made::Yes ❑ No JA New Construction: Yes 14 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ANo septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance .from nearest well-----------------Distance from foundation_--_---------------Material-_--_-------.--__-----_----___----- ------------ Z4:r ❑t No. of compartments--------------------------Size--------------- --------• ------Li p quid de th__-_- ... .... ...............Capacity--_------------------- Disposal Field- Distance from nearest well------------------Distance from foundation-----------------.-.Distance to nearest lot line-----_-.....__--_ ` �.❑.; Number of lines-----------------------------------Length of each line-----"----------------------.Width of trench------- 1~ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation....----------------Distance to nearest lot line-_--_----------.- ❑ Number of pits----------------------Lining'material-----------------------Size: Diameter------------------------Depth__-_-.---------_-__----__------- _e.�s� po,o : Distance from nearest we ------- ---------Dis Distance from foundation--------------------Lining material-_---__--------------------____----- � Size. Diameter----------- - ----------------Deoth---------------- Liq id Capacity------------- ----------.g-.alsv. IA- ----------------------------------- W',:', �Privy:�)tyvitCd� Distance from nearest well-.-. _? - �"- -------Distance from nearest building- Q �'Y1-i- arvk»--------- Distance to nearest lot line-A-----M-1'll-1-Mom------------------------------- ? odeling and/or re airing (describe):_�-E.S--- -- uY►� f 37 ! r )rt _: "►� -.l .l_�L._-� Q k a -�.G or = .... c-. .f,s ° ---`-'-'- e----`�S--- �.; ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- i ---- - ------------- - 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 laws, and rules and regulations of the San Joaquin Local Health District. Si'ned ---- _ ( g ) - -- ------------------•---------------------------- ---------------------(Owner �j - [ wn end/-Gr-Contractor) ' BY.= - .............(Title)--- '!/�� 1 -' (Plot plan, shoving size of lot, lot ion of system in relation to wells, buildings, etc., can be laced on reverse side). ' v P FOR DEPARTMENT USE ONLY Y: APPLICATION ACCEPTED BY- - ---- ----------- ----------=-- = REVIEWEDBY----------------------------------------------------------------- ------------- d-771---------------------- DATE------ •---------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Altirat'ions and/or recommendations:--------------------------------- ---- -------- -- ----"-"------------------------------------------------------------------------------------------•---•--- ------.-----------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------•-------------------------------- ---------- ------------- ------ FINAL`INSPECTION"BY.-_" � . V t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100 !