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1A1�q APPLICATION FOR SANITATION PERMIT Permit No. .--�h----_�___ [Complete in Duplicate] ,�� Date Issued _____=___X,/ 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..._Z�d � '� T Owner's Name----- � Phoneme 2 LV ----�-- i ---------------------------------- Address---- -------------•-_••_..- -- ---------------------------------------------- , ------------------------------------ ---- ` = I Contractor's Name--------` --`-I t-------------------------------- ------------- Phone Installation will serve: Residence &JO<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J �d -�c'I � Number of living:units ./___ Number of bedrooms Number of baths _L-'-_-- Lot size ________________________________�_ ______________-__-___ Water Supply: Public system 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 ardpan ❑ Previous Application Made: Yes ❑ . No Gg�%w Construction: Yes Eq 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 T k: Distance from nearest well_II/rn___L.Q_Distance om foundation__._ � :----Material_________________________ __ o;of com artmen#s______ Size__________" Liquid,depth____________________.Capacity. p _ Disposal ield: Distance from nearest well f�_Distance from foundation __&r__ _-._-Distance to nearest lot Number of lines---------- ��-___________ _____ Length of each line---------- Width of french-----2� t'_t ___________________._ Type of filter material---/R.% Depth of filter material-----I_f' _-__Total length___ _ _/______________________ _ Seepage Pit: Distance to nearest well____:_'_______:_____Distance from foundation_ __________________Distance to;nearest lot line_______________ ❑ {dumber of pits---i------------------Lining material-----------------------Size: Diameter------------------------Depth----------_--------------------- Cesspool- Distance from nearest well-------------------Distance from foundation--------------------Lining material---------- ._______-________-____". M ❑ Size: Diameter-------------------- -----------Depth----------------------------------------------------Liquid Capacity--------------------- ----gals. "�1 Privy: Distance from nearest well----------------------------------------------------Distance from nearest building__________-_______________________--_.-. O ❑ - Distance to nearest lot line---------- ..--- --------------------=--------------------••---------=----------•------------------------------------------------------ Remode{ing and/or repairing (describe): e)=--------------------------------------------------------=---- --- ----------•--------•-----------------------------------------••----•---------- --------_ 'i . -- ------------------------------------------------------------------------------- ------------------------------------ ------------- - ---- l' K 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 ne 9 ��f ------•---'----------------------------- ------------- = - 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). r . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------h-------- -�------------------------ DATE. REVIEWED BY---- --------`----------------- ---- ----------------- = = DATE- -- --- ---- - -= BUILDING PERMIT ISSUED---.--:-------- -- ---------------------------=------------- DATE Alterationsand/or,recommendations:------- -------- ----------------------------•--------------------------------------------------•--------------------------------------------------- k _____- _ _ ---------------------------- -_______________________________________ ______.___.._____..__-_-_._..____________________________________________________---------------------------- ----------____________________________-------------------------_------------_--------------------------------------------------------------------------------------------- __________________._____._____________________-_____ i ----------______-------------------------_-------------- _ f.� - -- ------- ------•FINAL INSPECTION BY:_- T Date = � � -------------------- SAN I 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 ES-9-2M Revised 1-57 F-?.CO,