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1 J . - r C l APPLICATION' FOR SANITATION PERMIT Permit No. ..._._`?_ .. ...S. (Complete in Duplicate) Date Issued ---•.- -7 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. ` JOBADDRESS AND LOCATION ( == �- --------------------------------------------------------------------------------------•-------....--------------------------- ' OwnersName------ fW � ------.-.-- 'ey ------------------------------------------------------------------ -- Phone---••----•------------------------- Address---------------- -• --._._..------------ Address---------------- ----42----_-------+d-= - ----------•----------._...-------••-- -----------------.-----------------------------------•----- -----------==-------- Contractor's Name--------------- --=---------------------------------------------- Phone. --1--491e'7- i Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. _ Number of bedrooms __Number of baths _l.__- Lot size ___ _._---------------------- � i I Water Supply: Public system � Community system ElPrivate F1Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: :Yes ❑ No'[] New Construction7Yes❑ '"No ❑ I=HA/VA:•Yes ❑ No ❑ TYPE OF INSTALLATION AND SPEED ICATIONS: 1 ' (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Sepfic,Tan Distance from nearest well:___________-�___Distance from foundation--------------------Material _______`__________.___-___________.._.____.__. Z No. of compartment`---f------------------i.--Size- •--------------=-------------Liquid depth---------------------- Capacity-----------•----------- ____ Disposal Field: Distance'from nearest well_________________Distance from foundation______._______._..Distance to nearest lot line.___-_ __________ G � � Number of lines---------------------------------f---Length of each line------------------------------Width of trench----------------------------------- Type of filter material__.__ _:;__________'.M_Depth of filter material-----------------------Total length------------------------------------------ Seepage --__-__-_____________._____________-____See a e Pit: Distabncce of nearest well---__-- • mDteraal e,f-Trn foundation___/--- ___.Distance to nearest lot line---------------- Number ____�__•_-_- p_. /} ILining' Size: Diameter---- --------Depth--- --------•---------• Cesspool: Distance ji-om neare t well___--__-_--'_-__Distance from foundation____________________Lining material---- ❑ Size: Diameter--=------- ---1------,--- ----.Depth---------------------------------------------------Liquid Capacity----------------------------gals. f a Privy: Distance from'nearest well-------_-----____--------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line =----=------ -------------------•-----------------------------------------•--•--------=-- ------ . } I Remodelin and or re airin describe :______ /___ ,,/ ; 9 / p g I 7 .l-- - -�4'L. J = --------------------------------------•--------------------------------- ----------------------------------------------------------------------------------- ----- J --------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ---------------- ------------- -----------------------------=----------=----------•--•--------------------•---•--•-----------------------------------•---•------------- ----------•-•--------•----••---------•---------- I hereby certify that 1 have prepared this application and that the.work will be done in accordance with San Joaquin County ordinances, Statle,`laws,/and rules and regulat ions of the San Joaquin Local Health District. (Signed ........ -- -- , -- (Owner and/or Contractor) ------------------------------------------------- BY� ff-------------�C ---------------------------- , (Plot plan, showing size of lot, location of system ir(relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---------------- ---------- -- ------ --=--- ---- ----=---------------------------------- DATE------------------------- -------------------------- REVIEWEDBY--------------------------------------- ------ ---- ----- -------------- --------------------------------------------- DATE-------- --- �s J I ----------------------------------------- BUILDING PERMIT ISSUED---------------- ---- ----------------------------------------------------------- DATE--------- -------------------------------------------------- Alterations and/or recommendations----------------- -----------------------------------•--•------------------------------------•--------------------------- -------------- j�--------- ------ ! cazlr.?`>�Z�Q _ � ----------.�er7-.e..---._.T/,/---u��---------------_------ ------------ -------------------- -------- 3f"-......�Sr i -----f�.;------- ' I - t� "--'-"--- 1 --._ ---------------------- - ------- ---- aa � k .�i � g-/I- 4-V COXVry ra Ce 7-y- wAr-� - �� s �.ey 6Ao,0, FINAL INSPECfflWBBC._'--- -------- - - . -------------=----- Date-------- y ---1-�--- 6- ------------------------ �� `� T AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef' JLQ; 0 West Oak S+roe+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California°ES-9-2M , Revised 1.57 F.P.CQ.