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' APPLICATION FOR SANITATION PERMIT Permit No. -- z ------ Application __ (Complete in Duplica#e} 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 10jrdinnce No. 549.JOB ADDRESS AND LOCA710N --- r Q Z �� ------------- Phone._. -�_ Owner's Name-------•---�l f-•-='-'=1==-------- :-- ----------•- ---- -- - f �? Address--•------- •----- ---- . :r:.r� - ------------------------------------------------ -- - - --�------ - --- =- -- -- - r_ Phone._ Contractor's Name_.__�!'•� �- - - -- -�--'-�-"-� �-�- Other ❑ , Com ercial ❑ .�, . r .. Trailer Court ❑ Motel ❑ Installation will serve: Residence A artment House ❑ Number of baths -- .-_ Lot size _ -_ Number of living units. __�-- Number of bedrooms ;,1 Depth to Water Table 02� ft- Water Supply: Public system Community system' A ❑ Private ❑ p Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand F1Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ ❑ NoX New Construction: Yes E] No � Previous.Application Made: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.} f . ...... Distance from foundation__X�----------.Materia___ "' Septic Tank: Distance from nearest wel�?� fI No. of compartments____ --- •----------- = _Liqu%d depth__..-- - ----- -- Capacity f sal Field: Distance from nearest well_____ _________Distance from foundation--------------------Distance to nearest lot line---------._.___._ I ispo - Number of lines------------------------------ ---Length of each line------------------------------Width of french----------------------------------- V ❑ {-. Type of filter material---------------�--��---j--t----Depth ofilter material----------------------- length----•--------- -------------- f1 Seepage Pit: Distance to nearest well�'�'f't��Distance from foun'dation__;1�..-----Distance to nearest lot line_ 1 De tin------ ! ` Number of its------- -- Lining material_ '� _Size: Diameter-- p ; p ! i Cesspool: Distance from nearest welL_______________Dfstance from foundation________________ ".Lining material_-__.._.--------------------------- Distance ______.--- - gals- El th -Liquid Capacity----------------------------9 I y ❑ Size: Diameter------------------ '--- ---- - p Distance from nearest building � Distance from nearest wail----- --- -------- ------ - ------- --------- - g---- ---------------------------- Privy: --- -------------- -Privy: -- . Distance to nearest lot.line-------------------------------------------------- - ---- --- -------- ------- -----------------•------------------------------ - --------------------- i Remodeling and/or repairing (describe) k _____________________________ ------------ ___________________________________________________ _-________________.._-- _______--____ I _________________________________________________________ J ..___'_____. w ________..________________.________-_ y. . I hereby certify that I have prepared this applicationa�nd that the work will be lone in accordance with San Joaquin County ordinance -State laws, and r !es and regulations of +he San Joaquin total Health District. Contractor) --� ��:��_ ----------------------------- --- ----(Owners/or Con+ or (Si ned g tic=• � ... �, -,� �✓ _ r i------------------------------------------ Ti#le_, , - : By /. _a..-.-- ..r-------- f r ..�. / f - (Plo+plan, showing size of�l'ot, iocation=of system°in relation'to wells, buildings, etc., can be placed on reverse siF e FOR DEPARTMENT USE ONLY +� APPLICATION ACCEPTED B -- - ------- ------------------------ DATE__t�---------------- --------------------------------- ` DATE------- ------------------"------------------=----------- REVIEWED BY --------------- -------------- ---- ----------- _ � - - -------- I A- -- -------- ------- DATE---------- ----------- --------------,--- --------------- BUILDING PERMIT ISSUED-------------- ----------------------------- •------------ - -- Alterations and/or recommendations:______________________________-._--�----.-.- -------=---------------- ---------- -------------------- Date_...____,. ------------ ,� G v ------------------------ - - -------------- -Y I - ---------------------- FINAL INSPECTION $Y:...---- - } �' ,/_lh SAN JOAQUIN LOCAL HEALTH DISTRICT 3D0 West Oak Street 132 Sycamore Street ` 81k North "C" Street 130 South American Street TracyCalifornia. Stockton, California Lodi, California Manteca, California y' FC-9_2M 10-52 Revised W-2100