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APPLICATION FOR SANITATION PERMIT Permit No, ' cafeete in (Complete Du liP I / Date Issued ___So��.(� t 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. . i JOB ADDRESS AND LOCATION__F _-✓`F- _ --------------•----------------------------------------------------------------------------------------------------- Owner's Name__' f - � --------------- r r.Y L-- ----. Phone------------------------- - Address------*7 IP_ -- �! T! --------------- --------------------•------------------------------------ r _ Contractor's Name------� i - --- � ----------•-------------------- Phone = - 7 I Installation will serve: Residence ® partment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __` _-_ Number of bedrooms __' Number of baths ___ __ Lot size --------. " j Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table AX-7-1t, Character of soil to a depth of 3 feet: Sand ❑ Gravel [j Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[I Hardpan ❑ Previous Application Made: Yes ❑ No ❑.., New Construction: Yes ❑ •No FHA/VA: Yes ❑ NOX \ 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-:��---Dist ance from foundation__/q-.._______.Material___Wovg4!_4---------.'_- i ( No. of compartments--------------------------Size-__-_,°3__<(S_—X,''__------Liquid depth---4....................Capacity.- - Disposal Field: Distance from nearest well__1)Z#A1if._Distance from foundatipn.r®__r_..___..___.Distance to nearest lot line_,:______--� 9 - �- ---------.Width of trench__,Z5✓.' --------- Number of lines-=_j---------------------------Len th of each line___ --- ._r3 Type of filter material__2P_4_A____-____Depth of filter material______ L ______Total length_---- Seepage Pit: Distance to nearest well_.W4 ?.------Distancefrom foundation_'�_'J____i........Distance to nearest lot line__ ��____ �] Number of pits-------- -----------Lining material----- '_._.Size: Diamete r___ -6 -__Dept h-------49___---__________________ Cesspool:'-` Distance from nearest well-----------------Distance from foundation-------------------Lining material_________-__________-_-_________-__. ❑ Size: Diameter---------------------=---------------Depth-------------=------------------ -------------------Liquid Capacity------------.---------------gals. Privy: Distance from nearest well__________________________------______________Distance from nearest building----------------------- ----------------- r� ❑ Distance to nearest lot line l Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------- --------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------- ----------------------------------- -----------------•--------------------------------:_----- I l 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, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- A7,-�_rti1'2- --l-p---l---L-'----�---- ------------------------------------------- --------------------(Owner and/or Contractor) . 8Y: - -............ -- ----------------------------------------------------------------(Tifle)----- ' - (Plot plan, showing size of lot, location of systen-in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------- ........ �r;:;;�-------------------------------- ------ DATE------------ e� REVIEWED BY--------------------------------- ) . - .` ,.r � -- .=-- -------- ----- -- ----- -------------------------------------------------------------- DATE----------- BUILDING PERMIT ISSUED i - - ------------- DATE Alterations and/or recommendations:i---------------- I ------------------------------ ----------------------•-- ------------ ---------- ---------------- : 7-- -- ---- ----�- =- -------------_�a•�!� u�,s ma----�f.� vv------%c ----- ---------------------------------------------- --------------- ---------------------------------- .,FINAL INSPECTION - - - -------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore-Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M , Revised 1-57 F.P.CO.