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Y \ ' APPLICATION FOR SANITATION PERMIT Permit No. __ _ - - in Duplicate)li � cate I (Complete �. 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 with County Ordinance No. 549. - ------------------ JOB ADDRESS AND LOCAT N ��€� ------ Owners ----Owners Name_______p ----•- ---------------------------------------------------------------------------- Phone------- ------------------------•-- ------------------------------------------------- Address_---------.-•1 ?it�/`------ ----- -------------------------------------------------------------------------- Contractor's Name---------------- � ------------------------------------------------------------ Phone--------------------------------- Installation will serve: Residence ga-"A�`partmenth'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms'-S_ Number of baths --A- Lot size A �rf��"------------------------------ Water Supply: Public system ❑ Community system &-�P`ri'vate ❑ Depth to Water Table 4VA/ft. Character of soil to a de th of 3 f tSand Gavel Sand Loam-El -Cla _Loam Clay Adobe Hardpan p ❑ y ❑ Y0 Y ❑ ❑ Previous Application Made: Yes ❑_ No �~New Construction: Yes UEf"'N-o ❑ FHA/VA: Yeo ❑ 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__` r____Distance from foundation-----AP-------Material-___ _ / ________________- No. of .compartments---- :....-..........Size_>;9X-"t_kA.4�6-�Liquid �depth-----_��------------------Capacity---��---- Disposal Field: Distance. from nearest well--------`'_`_.:_.Distance from foundation___ _--_.Distance to nearest lot line--- /i Number of lines--------.�._.____---------"1Length'tof each line------ - Width of trench____ ---------------- Type of°filter material-__._ __ De th�-of filter material_____ZtF __ Total len th_____ ________________________ \ �-Z i Seepage Pit: Distance to nearest well------ --------Distance,from fo ndation____� ___.-..Distan to nearest lot line___4-__-_71— ' Number of pita ------------Lining material�'/ �---Size: Diameter.----_JS-------- ------------ ------ ___________ ,Q Cesspool: _ Distance from nearest well-----------------Distance from foundation----------_~_.,.____.Linin material_____:__.___.:___-----.-_:_________ `V :- r,. 9 ❑ ;�.. Size: Diameter----------- z Depth-- -------------------------•------ -. Liquid Capacity-- ---------------- gals. 'u . .� , < Privy: Distance from nearest well-------__________________-'___------------------Distance from,nearest building_______________.-----______..___.___-.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling --------------------------------------------------- i v Remodeling and/or repairing (describe)------------ - _ /+I� -- -------------------------------------------------- - --------------------------- ----------------------•-------------------------------------------------------- l ---------- ------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -wriA(Signed)------------------- --------- (Oor Contractor) OY: --------------------(Title)------e,17r 1 (Plot plan, showing size of lot, location of system ' 'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ---------------------------------------------- DATE CJ-��C} r-�7 1 REVIEWEDBY------ - --------------------- ----------------------- - ------------------------------------------- DATE----------------------- --------•--------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------------DATE--------------------- Aiterationsand/or recommendations----------- -----------------------------------------------------------•--------------------------------------------------------------•------------•------------ --------------------------------------------------------------------- ----------- ----- i = ------ ----------------- --------------------------------------------------------------- -- --•- ------ ------------ ---------------------------------------------------------------.... FINAL INSPPCTI Y - ------ - Date _"•_ -- SAN JOAQUIN-LOCAL HEALTH•D1ST.RICT- 130 South American Street 300 1Vest'oek'Street ` 132 Sycamore Street ' 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M , Revisea 1.57 F.P.CO.