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,k'y�y� APPLICATION FOR SANITATION PERMIT Permit No. U (ComD plete in Duplicate)' Date Issued -- Application is hereby made to the San Joaquin Local Health District for a permit-fo •onstruct and install the work herein described. This application is made in.compliance with County Ordinance No. 549. 'c�- ('�3-3-S ©.PrA4Vi�iv 6-OL. I JOB ADDRESS A0 LOCATION. _ � _ 2 d �� Owner's Name-- —~ �f•yY�yam --------------- --------------- ------------------- Address Phone ------------ Contractor's Name....... Phone---- Installation will serve: Residence Apa tment House ❑ Commercial Number of living units: _�- �g ❑ Trailer Court ❑ Motel ❑ Ot er ❑ ---- Number of bedrooms 5_ Number of baths .----1'_- Lot size ------ s-- 8 Water Supply: Publics stem I ----------------------- Y Community system ❑ Private ❑ Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam p Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes p No ❑ New Construction: Yes ❑ No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) i Septic Tank: Distance from nearest well _ ""`-"•" r 1 r Distance fro foun ation-_-1_ -___.►vlateriaL_-.____ F` No. of compartments------: -._... $ize- '^ ------------- -- --- -=1_!�_- -----Liquid depth. - Disposal Field: Distance from near st well-------------- Distance from foundation.---_�- _ � �- -- n Capacity-._ e--- � r Number oz lines- --------------------------Length of each line_ D'�stance to nearest lot line_-- 4d_- �7t ¢a"17�i9'th of french. - p�- Type of filter material--__- _____ Depth of filter material-----/�(___'__ Total length---------I--¢D-------------------- Distance Seepage Pit: to nearest well---------------------- from foundation------------------- Distance to nearest lot line----------- Number of pits.---------------------Lining material-----___----__-- Size Cesspool: : Diameter-------------- Cess ' ----------Deptn--- ------- --------- ❑P Distance from nearest well-----------------Distance from foundation--------------------Lining material_---_. Size: Diameter--------------------------------------Depth------ ------------------------------ --------------- ---- -- -------Liquid Capacity-.-.--------- Privy: Distance from nearest well-------------------- ---gals. ----------------Distance from nearest building--___-._-_-----_-- ❑ Distance to nearest lot line-----------------------_-._ _- ------ ---.-.--.-._. ------------------ ----------------- - --------------------- -- - ------------------------- -- Remodeling and/or repairing (describe)______________ ______ } ------------•---------•-----•-----•-----------------------------•-------•---------- •---------------------•---------------------------------------•--- ----- ------ -------.- -- j -- ----- ------ -•----. -•- -- ------ ----- ------ --- = I 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"�d rules n rF.glulations of the Safi Joaquin Local Health District. (Signed)---------- f:- / 1 � ------ -----: -----------------------------------------------------------------[O By:_----------------- I [Title) caner and/or Contractor) [Plot plan, showing size of lot, location of system in relation,to,wells, buildings, etc., can be placed on reverse side). __ FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- -----r REVIEWED BY-- .- �(.n ------s'� -__ ----- DATE----.�------ -- ...... = ------- ---------------------------------- DATE .. BUILDING PERMIT ISSUED-------------------- -- --_------------------- ------- - ----------- ---------- DATE--------------------•--------- - ---------------------- -- - ---------- era ions and/or recommendations:---__.- - ------------------------ ----- -----------•----- ------------------------------------- -- ---------------------------------------------------------------- ----- - - FINAL INSPECTION BY... --ti---�`-.__-G� -� - ----------------------- ---• Date--.- -- 4- -------------------------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street t Stockton, California 132 Sycamore Street 814 North "C" Street 1 Lodi, California Manteca, California Tracy, California 5-9-2M 10-52 Revised W-2ioo