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APPLICATION FOR SANITATION PERMIT Permit No. ._ -.1--- ..... (Complete in ( P P Du licate) r (> f Y` Date Issued __1____7 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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- � Z(0------�--- ---------------- 7 .. Phone = �- / �(--- -------------- z Owner's Name------ -:`-S.._"",; ------- f_,t�__� 7�!-rL� ------ d- �f -��---- ---------------------------------------------------------------------------------------11 Address Contractor's Name----------------6. - �, ------------ Phone-------------------------_ ------= ---------- - Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�:__ Number of bedrooms ___(__ Number of baths __(_"- Lot sine _________________ Water Supply: Public system �rnmuriity•systemfl[D, Frivate .. epth.to•Water-Table t ft.. Character of soil to a depth of 3 feetAE��ew Sand L] Gravel E] Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe C] Hardpan E] Previous Application Made: Yes E] $ Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: P p ( wer is available within 200 feet.)r (No septic tank or cess ool permitted if u�blic se } �- J�_�td-- --------------- Septic Tank: Distance from nearest well_, � _ Distance from foundation___-�_____.�__Ma.tenal_ No. of compartments • Size_ � � ° �a� Liquid depth_.Y'"_� Capacity � 1`7 ------- ( ! Dis asal Field Distance from nearest ell_�_ .Distance from foundation__�_e'__-______.Distance to nearest lot line.N5�---___ P� t ------!Len th of each line-------- , f ) Width of trench---- ---------------------- Number of lines"________ g Tj ` Type offilter matePial__) r,_---Depth of filter material-------I ---------Total length------�_��---------------------------- i t 1 Seepage Pit: Distance to nearest well__________________"_'_Ditance from foundation______.______.__.Distance to nearest lot line--------- -❑ Number of pitsLining # } , ry,------ Size: Diameter� --------__----._ Deth-------------------------------- -------------- ---------_--- ---•----°- -___-___""__.---- Lining material ----------------- ----- • � ; Cesspool: Distance from nearest well-----------------Distance-from foundation F-1 Size. Diameter------- ----------------------------De�------------------------------------------ :. Liquid Capacity gals.11 ' Q ________________Distance from.nearesf buildin Privy: Distance from nearest well- -----�---�----- --- - g_----------------------"--------------- ----------- Distance _____.__•--- "Distance to nearest of line' 'k-7-7 --f -fes t „mss � . -------------------------------- Remodeling- and or irin (describe];- '-------- - ___.-______. _______________r-_______.__.__-_.."..______ --'-----------•------- -------------------- ---------------- ---------------- '�-`------ t t ----------------: - y,,.; ---------------------•----------------------------- IV ==== ---------------F --------------------- -- -------- -------- ----------------- --- ------pp -------------------_----.------------- - --- ---. - -•--------------------------- ------ ------------------- ------------- I hereby cerci that I have reared t is application and that the work will be done in accordance with San Joaquin County ordinances, State d re "F ations of the San Joaquin Local Health District k Si ned ---------------------(Owner and/or Contractor] Sy:----------------------------------------------__1 - ----•----------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location 1 system in relation to wells, buildings, etc., can be%placed on reverse side). ��.FOR'DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY------------ --- DATE-------- ----- :r -------------------------- REVIEWED BY r - -- --- DATE_ -------------•-------- BUELDING PERMIT ISSUED L --------------------------------------- DATE_____ --- :------------------------------..._."--- 1` Alterations and/or recommendations:I - •-------------------------------- -------------------------------------------------------------------------------- --------- ----------------------------------------------------- -----•--------------------------------------------- - --------------------- FINAL INSPECTION BY:--------- �'_- ---- - --- �Q.(- -- Date__.f__I_V_ ` -- 3�--------------------------------------------- SAN JOAQUIN L CAL HEALTH DISTRICT l 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.