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• h - APPLICATION FOR SANITATION PERMIT Permit No.,-_ __--a_ '6— F, (Complete in Duplicate) Date Issuedn'Z7r 1�e Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thwork herein wdesccd. This application is made in compliance with County Ordinance No. 549. e JOB A©l]RE55 AND LOCATION____�,-�_>�"�f-�',�T�••��_; Owner's Name_____________________ , ----------••----��'--�-�------�`+'10e/_!_!-�iQ�-4I-�-----f"MAEVOY�!-------- Phone-4-�!'-'1(C---? -�-ami--� Address----------------------- ,s --- -------------------------------•------- ------•._----------------•-•---------------•-------------- ii�Contractor's Name ----------------- --------�_ --------------------------------------------- Phone_ D Installation will serve: Residence Apartment House ❑ Commercial Trailer Court _ ❑ ❑ Motel ❑ Other ❑ �•�'"" "'Numberof liviii�units: g 4-INumber-of bedrooms _YrNumber_of baths ---if Loi;Size_..., O _- 10- ._-_:--- Water Supply: Public system El Community system F1 Private Rt Depth to Water Table.? ft. e Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [) Adobe Hardpan,' .,. i Previous Application Made: Yes [] No). New Construction: Yes ❑ No ❑ .49t44-. TYPE OF INSTALLATION AND SPECIFICATIONS: eo (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-----------------Distance from foundation--------------------Material __--._________________.__.____ ____._.______ IS44 S4 1112 No. of compartments--- ----------------------Size--------------------------------Liquid depth-------------------------- . CapacitY•-----.---------------- DisposalField: Distance from nearest well---.-------------Distance from foundation--------------------Distance to nearest lot line-_---___-__-__-_ • � 31 i�rll� Number of lines-----------------------------------Length of each line----------------------------- Width of trench----------------------------•------ Type of filter material____--_-----------------Depth of filter material___-.---.-----__----__Total length--_--_--___--___-----__---__-._-----_-___- I Seepage Pit: . Distance to nearest well-��-,-.'"__Distance fr fo ndation- ��+++ r op ./�s� Distance to nearest lot line__+.___.___ Number of pifs__'__1-------------Lining material�1 --.Size: Diameter_ Depth • } Cesspool: Distance from nearest well----- ----------Distance from foundation--------------------_ Lining Capacity__ .._____--______ .______...gals ' ❑ Size: Diameter-- ---------------------------------Depth -- ----- - ---- _,� - .-> p Y Privy: Distance from nearest well_ _.. Distance from nearest bwldrng --_ --- g �t ❑ Distance to nearest•lot line____ _ "°""""�- - � �- - - Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------- --------- -------------------------------------------------•-•----- ------------------ ---------------•---------------------------------------------------- q hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rue and regulations of the San Joaquin focal Health District. (Signed)___ __ f contractor) ------ - ------------ ----- (Title) ' Q_ of plan, sho i g size of lot, location system in relation to wells, building s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - -------------------------------------------------------- DATE ° G __, -- REVIEWED BY --------------- --------------- ------ DATE ------------------------- BUILDING PERMIT ISSUED ------ DATE ------------------------------------- A terations and/or recommendations:�_______________'._-__ --------------------- - ----: .-.- -- --- ---------------------- ------------ ------------- - ----------------------------------------------------- ------------ ---------- ------- ---------- ------------ � ----- --- ------------------------ FINAL INSPECTION BY: Date__. ------------------ ----------------- -- 0 ( .� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S}rasf I 300 Wes} Oak Street 132 Sycamore Street 814 North "C" Sfre-ef Stockton, California Lodi, California Manteca, California Tracy, California `" ES-9-2M B-51 Revised W-2100