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l �d d /0— -5 (APPLICATION FOR SANITATION PERMIT Permit No: .___.9..'f.'1f _... (-Complete in Duplicate) "` Date Issued --�-----,/__-- --__-_-- Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordin-ante No. 549. JOB ADDRESS ND LOCATIONt_ _�"-•�'__+____ __ h f/........ -------------------------------------- y Owner's Name : ' ' Phone. -- -------------- -------------- ------ Address....... " * -------------------------------------------------------------•------•------------•-----------.. .---- ,, M. Contractor's Name..-- 1.�L.k"' ----------------------=---------------------I-------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [R/' House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ED mber of living units: --y--- Number of bedrooms __ __. Number of baF'hs ---- Lot size ___ -fi _f _� _.__ e W � Water Supply: Public,system ❑ '�Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand [] Gravel Sand Loam Clay Loam Clay Adobe ❑ y ❑ y ❑ y ❑ 0„oHarclpan 0 Previous Application Made: Yes ❑ No R New Construction: Yes © No ❑, FHA/VA: Yes ❑ .No ® � X-1 TYPE OF INSTALLATION AND SPECIFICATIONS: p � war is available within 200 fee+.}, ( P � P P P �,,�i. _...._ t,�,�, Se tic Taokse fi� taDistancesfrom nearest wel _ ' 'Distan e. fromffoundafion_ '--.Mater.ial__ - - ,._ _______�_______________ I No. of compartments_ _..__ _ t__-_� 5ize___:_._� _ _ _p :___Liquid depth_____��_r-__---__-_Capacity___ - e ` Disposal`Field: Distance from nea est welDistance from foundation_ '? stance to nearest lot lire!__ _ Number of lmes___________ ____ ____f____ Length of each line____________: __ _ � ' Width of trench__-_____ _ f i , F - pt Type of filter materi51 r '' I)e'pth of filter material------------- -------Total length----------- ----_---------------- fSeepage Pit: Distance .to nearest well-________-_:_ !Distance from foundation-------------------.Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining la+erial---------------- -----Size: Diameter------------------------Depth----------_--------•------------- l "V Cesspool: Diis.tance f-ro-nearest well______________ Distance from foundation-------------..____.Lining material___________________-__-___________-. ❑ Size: DiameterY---------__ _Depth - Liquid Capacity gals. _ Privy: Distance from `nearest -------------------------------------Distance from nearest building------------------------------------------ Distanceto' earerest.lot ie !, i - f - --------------------------------_-------------- -- Remodeling and/or ------,_. -------------------------•- - --------------•------------ - -----------•--------------------------- -----------------------------•----------------=---------------------------------------------------------------- ---- --------- - I hereby certify thatl have prepared this applicatibn and +hat the work will be.done in accordance with San Joaquin County ordinances, Stats, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------------.------ r------ (Owner and/or Contractor � v _ By:---------------- `-I (Title) (Plot plan, showing size of�lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ .____- - DATE__ REVIEWEDBY-------------- ------------------------------------•--------------------------------------.- DATE "y �-----------------------------•---•--•-••------ -BUILDING PERMIT-ISSU_ED------------ DATE. ----------------------------------------------- -------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------ -�--•-•-----•--------------------------------------- 7. -----------------------------------------------=------ ---------------------------- ---------- ----------------------------------------------------------------------=------•-----------------•--------------------------•--- •---------- -----------•----------------------•--•------------- ' -----------------------•------------------------.-.-------------------•-------•- ------------------------------------------------------------------------•-------------------- --------------------------------------------- FINAL INSPECTION BY:------ -.----- --Cr . L 6Jf - ------ - � Date- ----- =------------------------------------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stack+on, California Lodi, California Manteca, California Tracy, California I ES-9-21x1 . Revised 1.57 F.P,CO.