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*2/ l APPLICATION FOR SANITATION PERMIT Permit No..__l..h.. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ____ll-? -1�-Q Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County . rdinance No. 549. JOB ADDRESS AND -------------------- / X 49 Owner's Name ---------s(f�-G__. f fid% Phone ------------------------------------ Address------------- SA • L�r� � ffr - .... ----------------------- ----------------------- '------- '----=-------------------------------•--•--•.....------- Contractor's Name-------- { -`--------,P-/ G---------------------------------Y-----------=1� ----------- "' ------- Phone -------------------- ...----•------- Installation will serve: Residence ❑ Apartment House ❑ Commercial eTrailer Court [3 e Motel ❑ Other ❑ Number of living units: i________ Number of bedrooms ________ Number of baths OW Lot size ____________•_______--_-__--______ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table A ft. Character of soil to a depth of 3 feet: Sand ErGravel ❑ Sandy Loam ❑Clay Loam ElClay E]Adobe E]Hardpan ❑ Previous Application Made: Yes E]No e New Construction: Yes No ❑ FHA/VA: Yes ❑ No J20" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- _ G SepVc Tank: Distance from nearest well--- 0_+_ Distance from foundation__�O_-f__.Mate�__Lal_`/,e,— __.__'__________._ _____--- ��tgtl't( No. of compartments__.___r ____,,y_L--__Size_ �t _ �� f quid depth____ .-.- _ ___ _-Capacity__o��.P---___ � Disposal Field: Distance from nearest well..�JP__.:__Distance from foundation__________-------- Distance to nearest lot line__t�!_______ ®� Number of lines ____.4__________ -______________Length of each line______(�_�/Q�j_.Width of, trench ___ref.____________________ Type of filter material-- :w Depth of filter Material ------ 1,e!! ...___Total len' gth______-�f------------------------ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation__________ ______--.Distance to nearest lot line _______.______.._ ❑ Number of pits-------------- -------- Lining`'mdlterial----------------------- Size: Diameter ------------------------ Depth --------------------------------- Cesspool: Distance from nearest well---- -------------- Qistance from foundation -------------------- Lining material ------------------------------------- ElSize: Diameter-------------------------------- -- -Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ---- _------------------- .___-_-----_-___-_ r❑ Distance to nearest lot line--------------=--------------------------------------------------------------------------------------------------------------------------- , Remodeling and/or repalring (descri(_ie);:,r-___,__ �(_ __a%i _- _-- __-- - - -----• ---- Ir -_----_•------------- t------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ -- ------------- , nt -I Hfl_1�R_svn( ,�'S %Y� - ---------------------------------------------- ---------------------------Ir-------------------------------------F.a�- �-�----=�&0------------------------------ g.p------ ----------------------------- ----------------- Ir TA 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. y �_!r ---- - ° --- Contractor (Signed)----------------------------- -- ------------------------ -� ) 4 ' t = J---------------------------- ------- Title 1 Y• (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -.a=------------K------------------------------------------------------- DATE-----y----------------------- -/_REVIEWED BY-------------------------------- --------- `---------------- -- --- -------== = -=-:-==�----=_-----_--=---=------- DATE----------------•----------- - - BUILDING PERMIT ISSUED ------------------------------------------------------------------------------- -------------------- DA•TE-------•------------ - - ---------------------------------------- Alterations and/or recommendations-----------------------------------------------------------•----------'`-:-----------------------------------••--------•-------•------------------------------- ------------------------- - -------------------•--------------------`------------------------------------------------•---•-------- ---------------- •---------------------- --------•------ v FINAL INSPECT) Z�2-- - ----- -- Date_ - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -92M Pevised 8-'S9 F.P.Co. 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