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APPLICATION FOR SANITATION PERMIT Permit No. 2�W 33----- r (Complete in Duplicate) 3�y. Date Issued _-- -----�5- -- 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 __�-- ft /�r`Sn_ ✓ JOB ADDRESS AND LOCATION________ ____ _ - - -____-- --��i------��._._ - .- _-- -- •-•- ------- yy ---- Q Q� Phone. ` Owner's Name- i�-QI-�•-�---- �- 9-- ----=rT'" - f - - - - -�-------------------------- --- �6-��. - l� Address--• ----- _la.W... Contractor's Name 1�- ------ ► r V�cl------------------------------------------------------------ Phone �7-0-5 [installation will serve: Residence ®impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E-] Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -___-..---_----.______________________.---------_----.-__- Water Supply: Public system ❑ 1Commun'ity 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 ID No ❑ 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.) S •�a . Distance from nearest well, -----=-Distance from foundation---------------- --.Material.-_-....-----_----.---__-_-___-_-._ . ----------- No. of compartments---------------- --------Size--------------------------------Liquid depth--------------------------Capacity-----------3- E i Val Distance from nearest well_rjl1��_.Distance from foundation___l_�_._____.Distance to nearesNumber of lines___ ______ __: _ Len th of each Gne ±Q__�_ Width of trench___._g f Type of filter material- `' Depth of filter material--------- 0---------Total length--------- _ ______ ---------- Se a Pit Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line__.__-___-1C Number of pits------ ------Lining material------------------------Size: Diameter------------------------Depth---------------------------------- Cesspool: Distance from nearest well from foundation--------------------Lining material-_-_____----___-__-.__.___.__-_,__._ ❑ Size: Diameter------------------------- ----------Depth----- ----------------------------------------------Liquid Capacity------------------- --------gals, PrivDistance from `nearest ivelL------------------------------------------------Distance from nearest building------------------------------------------ y: { ❑ Distance to nearest lot line-----------------------------------------------•-------------------------------------------------------------=--- ---•---- -- ------------- �i Remodeling and/or rep (des ibe�: -� 1 ---- ----- - -------------- �/ �-- -------------- - I hereb certify-fhat-1 have prepared this application and that the work will be done in a rdance with San Joaquin County ordinance , Sta laws, and rules , nd r ulation of oa uin Lo ' t. d _ (Signe AUa- -------`f4 -A - - ----------------- _ ------ -- -- ------- ----- - --- -------- By: -------� *�ontraetor� K� B "_ (Title} ------------------ --- ---------------------- (Plot plan, showing size of lot, location of system in.rola ' n t wells, buildings tc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----!- ----- ------------------------------------------------ DATE------- Z ` `t� ------------------- REVIEWEDBY------------------------------ .w------- -- --------------------------------- ------------------------------------------•--• DATE------------------.----- -- BUILDING PERMIT ISSUED---------- ---- D TE------------------------ : r- Alterations and/pr recommendations f/___ __..__.__ -___ _____ - -��-��--�-{ r° - - - 1 --- 1 -------------------------- ---------------------- ------------------------------------------- I ----------------------------------------- --------------------------------- FINAL INSPECTION BY:..__�/j? )--- ---- - ---- ----=--------- Date---- -�---- -----� --------------------------------------------r SAN OAQUIN 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 Reviseci 1.57 F.P.CO. i' -