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- 1 APPLICATION FOR SANITATION PERMIT Permit No. �Q_7_2-1.._. (Complete in Duplicate • Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------J-7 � UQ,! 1 -----��----------------------------------------------------------------- ! Owner's Name--------------X_�_- - ......... - - ----------- ----:---------------------------------------------------- Phone--#--d---- --------------------------- =�3 � � Address ---- - ------ Contractor's Name__l ._'462__RL - ------------------------------------------------------------•-------------------------._. Phone--------••--------------••--------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j----- Number of bedrooms ___ Number of baths -_J____ Lot size _,�Mc�-�X__ ?__ ___._______________________ Water Supply: Public system ®__&mmunity system ❑ Private ❑ Depth to Water_Tabler110ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ElClay Loam E] Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No g-`� New Construction: Yes [a"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 Tank: Distance from nearest well- - ._Distance from foundation___1_�___________-Material_____l.(l.Yk No. of Dis oral Field: Distance from compartments. nearest well �tiv"ytt- D'iscan e�from foundation -- --p�h--Distance to nearest lot line------ Number Number of lines---------`3_-__----- - --------Length of each Iine______S .,_ Width of trench.__ 2 Type of filter material____ _ _- 4-------_Depth of filter material _-J.1---_ ---------Total length------16_p----------------Al___ 1 See pa Pit: Distance to nearest well__'y__---------Distance fro foundation----IiQ-----------Distance to nearest lot linef_ [ Number of pits----3--------------Lining material--- -----.-Size: Diameter------ �r Dep, _----�� Cesspool• Distance from nearest well-----------------Distance from foundation----------.---------lining material-___._._____.________________--____ ❑ Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity-.-------------------- gals. J Privy: Distance from nearest well._.. ______________________________,_..Distance from nearest building-------------------------------_--- .._. W ❑ Distance to nearest lot line---------------------------------------------- ,��) Remodelingand/or repairing (describe};--------------------------------------------------------------------------------------------------------------------------------------------------------- ;I --------------•-------_-----•--------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- C. --------------------------------------------------------------------------•-------------------------------------------------------------------------•---------- --------------------------------------------------------------- rb ------------------------------------------------------•-----------------------•--------------•---------------------------------------------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C ordinances, State laws, and rut s and regulations of the San Joaquin Local Health District. (Signed} - � �� '�'�/-� -�r -------(Owner and/or Contractor -- ----- ---------------------------------------------------------- By:--------•---------_ ---------------------------------------------------------------------------------------------(Title)--------------------------------------- ------------- v (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .. - APPLICATION ACCEPTED BY----- _�3 ------------------------------------------------------------- DATE---- REVIEWEDBY-------------------------- ------------------ -------------------------------------------------------------------------------- DATE f BUILDINGPERMIT ISSUED.__,------------------------------------ -------- -------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------- ------ -------------- ----------------------------------------------------------------------•-----------------------•-------------------------------- -----------------------------------------------------------•--------------------------------------- -------------------------------------------------•-------------------------------•-----------..-------------------------- ------------------•--------------------------------------•---•-----•-------------------------------- -------------------------------------------•-----------------------•------•--------------•------------------------- ---------------------------- FINAL INSPECTION BY:----9Fs' -------------------------------------- J Lf ------------------- - - Date--------- �^ SAN 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 ~ E5-9-2M , Revisad 1.57 FP.CO.