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Y APPLICATION FOR SANITATION PERMIT Permit No. .F7op r (Complete in Duplicate) Date Issued ��_-/d ...... s plica+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. JOS ADDRESS AND LOCATION_. J / ©y S p Owner's Name--'-+�-•1- .i'/ Q `--------ll-_X-�---------------------------------------- Phone- Address --------•-•----•---•-----------------(J@ f �r ` Contractor's Name ------------------------------------------ YiP°f',fS _i.- Phone__�/_L�.' i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- 1--- Number of bedrooms ___Number of baths I___ Lot size ______%L .-_�--1r-�_-'_------ i Water Supply: Public system M-4ommunity system C] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel E]Sandy Loam E] Clay Loam E)Clay ❑ Adobe �ardpan E]` Previous Application Made: Yes E] No New Construction: Yes El No Elr TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic, T k'. Distance from nearest well ----------------- Distance from foundation --------- ..-.------- Material --___________-----________________---___-_____-- I i No. of compartments-------------- -----•------ Size ------------------------•--- --- Liquid depth---------------- --------- Capacity ----------------------- po�s Distance from nearest well_________________ Distance from foundation -------------------- Distance to nearest lot line ----------------- Number of lines ---------------------------i - - -Length of each fine ------------------------------Width of trench ----------------------------------- Type ----- • --------------------------Type of filter material----------------- -------Depth of filter material---------Q'----Total length -------_-------------------/-©---- r Seepage i : Distance to neare t well—f-641---__-Distance fro} fo dation__ ______________.Distance to nearest lot line__.________.___._ Number of pits--- ----------------Lining material.--^----��--'t --Size: Diameter__ ��------ De th__ d P �_ Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material---_____---__------_--______--__,: ; ❑ Size: Diameter ---------- ---------------Depth--------------------- ------ ----------------------Liquid Capacity ---------------------------gals- M Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------- .-_________--_.--______-_-_., ❑ Distance to nearest lot kne---------------------------------------------------------------------•- -----------------------------' t Remodelingand/or repairing (describe)J---------------------------------------------------------------------------- ------------------------------------------ ----•- ----- •---------------•- --------------•----•----•----•------------•--------•--------------------------•--•-------------------•------•---------------------•---------------------•-------------------------•--------•--------------•---------------- r -----------------------------•--------------------------------------------•-•------------• ----------------------•••-----------------------------•--------------------------------------------------------------------------- I here cerci that I hav re are is applica ------------------------------------ion and that the work will be done in accordance with San Joaquin County ordinances, ate I s, and rule n regu tions of t e San Joaquin Local Health District. O (Signed)-------------- --• -- -- -- - ---- ---------------------'-----�- ------------ -- ----- --- --------- Contractor) 0 By: --•- --- -- --- : -(Title ` i (Plot plan, showing size' of lot, location of system in re ti n to wells, buildings, tc., can be pla reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ - DATE;---------•------------------------------------------- REVIEWEDBY--------------------------------------------------•------------------ DATE ---- �t� a BUILDING PERMIT ISSUED------- ----- --------------------------------------------------------------------------------- DATE-------- ) Alterations and/or recommendations:------------------------------------------------------------------- ----- ------------------------------------•---------------------------------- ---------------------------------------------------------------------------• ---------------------------------------------------------------------- --------------------------------- ----------------------------- - ----- -----------------------------------------------------------------•----•--------------------------------------------------------------------- Jf f r FINAL INSPECTION BY: ----- ---- _.. -- -�--- ---------------------------Date--------------------------j-�--"".�--`"�=---------------....---• 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 ES --9-2M ; ' Revised W-2160