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,V 1 APPLICATION FOR SANITATION PERMIT Permit No. ..f-� Date Issued (Complete in Duplicate) ,,fel _ • - - - — � . • _...� - " Application is hereby made to the San Joaquin Local Health District for a per it to constru and install the work herein described. This application is made in compliance with County Ord1nance No. 549. ��- JOB ADDRESS AND!LOCATION__{..---v� c�,�..-.. - ' - hone ._... - ---'�-••-- --- - ---- - Phone-4 -� J Owner's Name--------.-.- - _ _ / , Address------_----------.�'�<�� .rVf C1./S�.Tr.---................ � �'Y: ... -----•---------------------------- -------........... - _ ' Contractor's Name-----�---- ---- •---��Y�-�3.1�----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Mof6l ❑ Other ❑ Number of living units: Number of be .. Number of baths __. Lot size ---f9/-.-A._IR.e........ -- ----- Water Supply: Public(system Community system [I Private ❑ Depth to Water Table aft. Character of soll to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No PHA/VA-. Yes E] NoA TYPE OF INSTALLATION AND SPECIFI/CATIONS:.), (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sepficjank: Distance from nearest well-----------------Distance from fourdation__..-------------..Materia............-..._- .._- ...... "_' No. of compartments-__ . . Liquid da th.._----------------------Capacity.-...---......._!..-.. Size - ... -------- q P. i' -J � A/-�r..Distance from foundation.../11._.�.___.Distance to nearest lot lin/�__j......__ p • ispo Id'. Distance fror nearest ell-- / �A/idth of trench.___..2 N Len lh of each line = Number of lines--- •----- 9' "�i XType of filter material....:. 1P_C�r-....Depth of filter material-._._f> :.____._...Total length-.--___ Q.......................... QA ._Distance from foundaticn.....lQ ---.Distance to nearest lot line`__ Seepage I . Distance to neares`. well-_. Si '!-------Depth- . Linin {rnateriaL_.:_._�A��_---Size: Diameter_ P Number of pits______---•--=- - 9 I Cesspool: Distance from, well................Distance from foundation-------------_�...-..Liming material__.____.._.__..- -------•-"'-als. i ❑ .Liquid Capacity--•-•-------------- ------- Size: Diameter-------------- -------•-•-----•------Depth----------_-•.-•--------••- ...._.__.. 9 Priv Distance fromInearest well..__.________________ ______---._:----Distance from nearest building._..-............___........ . :_---- Y:. • ❑ Distance to nearest lot line:----••..••3----• ..................................•--••--... ------------- -- Remodeling and/or repairing [descrtibe):__.. �" > 1 - ------ - -----•- •- ---•----- - ----------•----•-.-_------ ......... ------------------------ ---- - ---- •-----------._.-_...... ------------------------............--.----------_ ------_--- .----------....-----...._..-•----..........•__...._..... ....... ...._... ... I hereby certify that I have prepared this application and•fhat the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regula ' n of the San Joaquin Local Health District. ,/..__. --- ----- Owner and/or Contractor) (Signed) f_.. ✓�- -- ------------- (Tit e)_ - ....- (Plot plan, showing size of lot, location of system in relati o wells, buildingP s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------- DATE Z . Z� -----------•------- r REVIEWED BY------------------------ ----------- ------ ................................ = DATE ------•---------- -------------- BUILDINGPERMIT ISSUED-----------------................................................ ------------ ------------------ DATE-------- ---------------------•------------------•--••------ Alterations and/or recommendations:.----......................... ..................................... --------- --------- - --- .... ---------- ._... 1. ...... . ......... FINAL INSPECTION-BY::. .-.-.. ,- -- ........................ Date_.. .'� ! ... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street [32 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y, ES--9-2M Reviwo 1.57 F.P.CO.