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<< �„ �� APPLICATION FOR SANITATION PERMIT Permit No_ _____ (Complete in Duplicate) +*Zvi�Date Issued ------- . Applica ion 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 r�. - 1 __ /�! --------------- ---=-------- � ��/ Owner's Name------------------ A/�-------- 5 •----------------------- _,----------------------- Phone---�"- Address--------------------------- ---------- fe_tl__&:�,_*4r----------ew ---------------.- - Contractor's Name-- - '�• '/ 5 9�5 .�l.S-----��n/ =------------------ Phone-+�s1'� 0� G- Y I Installation will serve: Residence -Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units; ._I___ Number of bedrooms . Number of baths ___ -. Lot size -------- _�t_--`� s_________________ Water Supply: Public system ElCommunity system ❑ Private �r Depth to Water Table .,/oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made- Yes ❑ No X New Construction: YesA No ❑ FHA/VA. Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ;. Septic Tank: Distance from nearest well �_100--:-Distance from foundation__:.l ___ f - O �/ No. of compartments------ O----e%-�•-__-_--Liquid depth----��------------Capacit _fQC 1 Disposal Field: Distance from nearest welI_ �_�___._.Distance from foundation-_l�--------Distance to nearest lot line- .. -.-... Number of lines___________ _____________-------------Length of each line-----'1Z?--- __p�-----Width of french-----__�_?:��___.____._ Type of filter material-----�C�C_C___Depth of filter material____._1jV_,......Total length--_ ��_ -: t-__----_--------_--------------------- \\^\ 4� V' Seepage Pit: Distance to nearest well----��_ -__-Distance fr foundation------`J4�.___.Distance to nearest lot line-2_L_.__._ W Number of pits------/-------------Lining material-_---_-_ [.Size: Diameter____- s�_- X25`-__------_____:_.. Cesspool:. Disfiance-from nearest well ---------Distance from foundation--------------.---_.Lining material-----.------------t----------------- Size: Diameter_ �] ,` ------=----------------Depth----------------------------------- ---------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__-----_-.-_--.---_------_----.----_:__-. k ❑ Distance to nearest lot line---------------------------- -------------------•------------------------------------------------------------------------------ - ` - Remodeling and/or.- repairing (describe):----- ------------------------------------------------------------------------------------------------------- ------ a --------------------------------------------------------=---------------------------=-----------------------------------------------••------•--------------------------------------------------------------- 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"Py rules and regulations of the San Joaquin Local Health District. i (Signed)-------.._-•------- --------- — �/�--�� J-- -`'��'� C�{ �' =----.(Owner and/or Contractor) -y:.----------- c C�`��.-l�rr --------------------------------------- (Title) ;te r (Plot plan, showing size o ot, location of system in rela n to wells, buildings, etc., can be placed on reverse side). �' FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY------- ----- _ ----------•--•-------------------- DATE---------- -•--------------------------- REVIEWEDBY---------------------------------------------------------------- ---------------------------------------------------- DATE.------- .� BUILDINGPERMIT ISSUED----------------------------------------- --------------------------------------------- DATE- - `�� --, -- -------------------------------------- --------------- .----.- -------- ---------•- Alterations and/or recommendations-----------------------------=------------- - ------------------- 1 --•---------•------------------------------------ �I. off/l$;- ------------�'�/T__ � + ------�-7-----� -------- - r ------------------------------------------------------- -------- = FINAL INSPECTION BY: -------- R- Date-------- rr .'l-- `5--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street aro North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseo 1.57 F-P-M