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- ��. APPLICATION FOR SANITATION PERMIT Permit No (� (� / a 3 �2 d (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. This application is made in compliance wifh•County Ordinance No. 549. r JO&ADDRESS AND LOCATION_____ ZX_0 Owner's Name_ -----� ----gyp.4 t- C2 ' U-�9 Phone ------------•---------- Address- Gt'i--1 3-7-Contractor's Name___;T6e4__-_s��C,�� `�1_ep--------- ------------•------------------------ ------ Phoned Installation.will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___+___ Number of bedrooms e Number of baths ___/___ Lot size _-_. _� / _ Water 5u Public s � - -- "----------"--- """"- PPY:I stem y ❑ Community system ❑ Private K Depth to Water Table -------- ft. Character of soil to a dep+h of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan•n Previous Application Made: Yes ❑I No<_ New Construction: Yes Na.❑ 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 nearesr well___!� "--,Distance from foundation----e��__-_____---Material-_ Es�_(yQe 5Q No. of cbmpar+mems------�.------.--- Size_ �X i ----------------------- _ ?- - --Liquid depth ,-- Capacity ----�-G - Disposal Field: Distance from n�arest wefl._-._ -- " .._.Distance from foundation �x4_---- --- A IS re to nearest lot line_'----_____ Number of lines_!____--__ 5D ----Z---------"---Length of each line_- -f11/i of trench-----.Z,fi-"_ Type of filter material___-_?6e. - p y 3u rn f� yp Depth of filter maternal_._.-1$-__-_. ----Total length---------�0_�--------_--- ----------- ��it: Distance to nearest wel6__--__/V-_--------Distance from foundation___-•J�..___- ' --Distance to nearest lot ['Q Number of pits-_�__.-------I-------Lining material-__9�_4__f----_ .Size: Diameter -__ Depth --------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation____________________Lining material---__-_______________-_____________- ❑ Size: Diameter ---------------------------------Depth------------------------------------------ � - -------Liquid Capacity----- --------- ---------gals. ....Distance from nearest buildin F1 Distance to nearest lot line-------- -------------- g Privy: Distance from nearest well ------------------------------------------ ----------------------------------------- Remodeling and/or repairing (descriGe):_--- ------•-------------------------------•---I- ------------------------------------------ -----•------------------------------- ---•---------------------------------- ---------------------- ----------------------------------•---------------------------------------------------•----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, and rules an regulations of the Sari Joaquin Local Health District. County 1 {Si ned g C� G � ---------------------------------------------------- By: ----- ------------ (Owner and/or Contractor) --------------------------------------------- By-------------- Q - -----------•----------------------- ------------------------------------------------------ ----------------------- ----- - -- - -----(Title)--- �ctrrc t� (Plot plan, showing size of lot, locatio* of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------___ _._ --------------------------------------------------------- DATE_. REVIEWED BY----- -------------•------------ $'�------ ------ --------- ----------- -- ----------"--------------------------------------------- DATE----- Alter NG PERMIT ISSUED-------------------------- --------------•-------------- DATE -------------------------------------------------- Iter tions and ar recommendatia s:___-/1 _ - --------------------•------------- ------------------------- '.r. _ ------ ---------------------------------•--- ---------------------------------------------- r I FINAL INSPECTION BY: # ---------------------- ------ 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 f E5-9-2M . Revises 1.57 F.P.CO.