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3 APPLICATION FOR SANITATION PERMIT Permit�No. - ..~" •••"_ f� 77, (Complete in Duplicafe) (�l I Date Issued v Applicafion 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 L bio e 2a . JOB ADDRESS AND LOCATION___:_- /`�' " _ _p2V rFf_ L 1 �P r - - -------- Owner's Name----------------'-- �--=-- �f /�f-'g-'/lr1 --------------------------------------------- Phos Address-----•-----•-"----- --"_"-�•�"--��"-••---••-----"•--- ------- Contractor's Name---- f - •-------•--- ----------- ---------- ------------ --------- ----------- Phone---------------------------•------" Installation will serve: (Residence Apartment House ❑ Commercial ❑• Trailer Court ❑ Motel 4❑ Other Number of living units: __1---_ Number of bedrooms � !� j�f � Number of baths ._ _---- Lot size _-_-__- ------------------------- --- ----------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft: Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Har� ❑ Lobe ❑ dean ❑ Previous Application Made: Yes p No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan; or cesssp�ol permitted if public sewer is available within 200 fee}.) Septic Tank: Distance from nearest well 4"'-----------Distance from foundation- ": No. of compartments--------- Y �X .5 X. Y � --" V + : � Size Liquid depts � G ---Capacity----- Dis l Field: Distance from nearest well__.------------_-.Distance from foundation:�-_�d_e----.Distance to{nearest lot lino__"- N'umberkoi lines--------------y------_-------Length of each line----------/ - ---_----.-.Width of trench------------?--`-' q �/ ------------- Type or filter motorial- -s- . Depth of.filter material--_- _I -_------Total length-_-----"----— 0 ,.'. "`" . Seepage Pit: Di Lance to nearest well----------------------Distance from foundation---._.--_-_.-1_--.Distance to-nearesf lot line_-.--_.-__---_-_ ❑ Numbercof pits'"" ------Lining Lining mafierial ' -------------------Size: Diameter------ Depth----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------_-.1mings'material .r _----_-----__ 'Lo ----------------- I I Size: Diameter Depth _-Liquid CapacitY---- ----------------------- dgals. Privy: Distance from nearest well-----.-------------- I ��......,.+---�...---�--:�-. ------------------Distanco from nearest bu"riding�------------------ ---------- -------- F1 Distance to nearest lot line- -- ---------------------- Remodeling ---------- ------•--Remodeling and/or repairing (describe): i --•----------------- # ---------------------------------------- --------------- --------------- "--•----- .—M---------------------------------------------------- ----------------------------- ------------------ -------------------------------------- -------------------------------------------------------1--- ., J I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St?Te,,,a.w0, and r I and regulations of the San Joaquin Local Health District. I t (Signed)__-- -- _._-----{Owner and/or Contractor$Y:------ --- �----------•---------------------- -- -- ----- - - - - --------------------------- - - ----------- -(Title)--------------------------- � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -------------------- e } FOR DEPARTMENT USE ONLY APPLICATION ACCE , OBY--------------- -"----._ --------------------------------- DATE------------- "-" REVIEWED BY /& .. .-- ----------------- --- ---------- - - --------------- --------------------------------------------------�` DATE---------------------•••`- ----- -------------------BUILDING PERMIT ISSUED--• •--------------------------- -- ----- --------------------------------- - - `' DATE--------•------------ I Alferations and/or recommendations:------_ - 1 -------------------------------- --- ------------------------------ ------------------- ------------•----------- -------------------------------- ------------- -------- 6q FINAL INSPECTION BY ------------ --------------------- 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-9-2M 0-52 Revised W-2100