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APPLICATION FOR SANITATION PERMIT Permit No. ~ (Complete in Duplicate) Date Issued. -._f-0- 513U Application is hereby made to the San Joaquin Local Health-District fora permit t ' This application is made in compliance with County Ordinance No. 549. P o construct and install the work herein described. JOB ADDRESS AND Owner's Name---- ------------------------------------ Address ame--- , ,,� / -r ---------------- --------------- --------------- ----------- ---------- ---Phone/_`�t�- ---�------- �''� ---- Address_------�•-�'---��' �----NYU-----�--"-�1=.�0�------�--- -• =------ ---' Contractor's Name-- _F-lp- ----------- Phone- ---�--f�p%-- - Installation will serve: Residence 3---Apartment House ❑ Corr}mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number`of living units: J____ Number of bedrooms __L3_ Number of baths -_�___ Lot size ._____ _ ____ r'fT' ---------------------- Water Supply: Public system ❑ Community system ❑. Private 2-�epth to Water Table -.J-ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam [❑ Clay ❑ Adobe [f�H rdpan ❑ 1 Previous Application Made: Yes ❑ 1ENo New Construction: Yes �o ❑ 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_/Z2W------Distance from foundation---OQ----------Material_.a-f _- p�a� ,� , No. of compartments__.-__. �a----------_ ,�r Liquid depth__ __Z�` ----------Capacity----- Disposal Field: Distance from nearest well._-_t0-.._.Distance from foundation__,Z_Q--`___Distance to nearest lot r [ � Number of lines----------- ---------------------Length of each line_ ------_-s _. ---..Width of trench-----Z_,¢ ------ Type of filter material_ 4PC/t____Depth of filter material__f..�_"'.--------Total length-----------k f)--- ------- Seepage Pit: Distance to nearest well-40,0------------ from founclation_, )V---------Distance to nearest lot line__ _.-f Number of pits-----/-------------Lining materia��e eJ3/&�_-Size: Diameter__.. _'V-------.Depth_.._.. �� 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 ❑ Distance to nearest lot line.------ ' < Remodeling and/or repairing (describe):_____.._ �� __-_-- -11ey -f�, ----------------- ------------------ -----------•-------•- -•- -------••-------------------------------------•--------------- ------------- ---- - - ------ ------ ---- - - -- -- - -- ---------•--- --- -- --- ------ - - - ----- 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. f (Signed)------ �• �7'r �� -!�� .F �✓cs - / - ` c,l /� '---------------------------------------------(Owner and/or Contractor) ��- ------ - ----------------------------------------- -- - - - �'---------- (Plot plan, showing size of lot, locatiohi.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _- ' ` �. - -------------------------------------------------------- DATE---•------------------------------------------------- " REVIEWED 8Y - ----- - DATE-- -- ---------------------------- - �---- UILDING PERMIT ISSUED-----------!t••---------- --------- ----- --------------. DATE-------1. --• Alterations and/or recommendations_________________ _ _-- 11 V. -- -------•---------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------•--•------------------------•-------•--------------------------- ----- ----------•----••----•-----•------••----------- ----------------------•--------- ! - ------------- - ------- --------------------- ---- 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 io-52 Revised W-2100