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APPLICATION FOR SANITATION PERMIT Permit No. _.Z. _.L2_ (Complete in Duplicate) ,. .�... Date Issued i Application .is hereby'made to the San Joaquin Local Health District for a permit to construct and install the work herein esc 'bod. This application is made in;compliance with County Ordinance. No. 549.; } f • ND LATION__ ...................... s _O P. _r .. .r�.. .. .r.a ... .alroTuw••�...u.., ..JOBADDRESS A . . 1 . . _10 s Name— " Phone..............• ner •-•------.L .......... --- . --••- :. n ..........-- ----- _......:.....-.......... Address �. Y _ Ile , Contractor's Name-- - -- _t'- ------------........................................... Phone Phone..�................••_...._----•-. a _ Installation will serve: Residence f� Apartment House ❑ Commercial ❑ Trailer Court 0 Motel C3: ❑ , Number of living units- .1...... Number of bedrooms off_. Number of baths -J._. Lot size .I, O t _d................... .......... Water Supply:"Public€system'❑'Com mruriifiy —Depth to'Wtlter.fTab]a y!Fft:' Character of soil to a`depth of-3 .ieet:l Sand E] Gravel [� Sandy Loam® Clay Loam ❑' Clay E] Adobe C] Hardpan 91 Previous Application Made: Yes E] No•❑ New Construction: Yes ❑ No ❑ FtiA%VA-Yes ❑ No❑ �( . . TYPE OF INSTALLATION AND SPECIFICATIONS: i ;.(No septic fanV or.cesspool permitted if public sewer is available within 200 feet.) Le Septic Tank: ; Dist ance.from`nearest well....•`ja.__.._Distance from foundation../d._. A!.N4bterial._ ..........................:........... r. a s ;: : r3 .�r , Size--- •-----_-...- .. Liquid`de th_-- � No..of.compartments_....-.......-----•--� . $� r --.... q P. �E----...----•----.Capacity.......:........... � Disposal Field: Distance from nearest well._r_: ... .Distance from toundation._•�- .......Distance to nearest lot line_.�r..�_._.. y' _:'!`_. .-.J' $_.WidT-th•e«of rfi re .....................Number os ines..___. .N..-- Length of each line O Type or filter material_1.-5,- .- l -----Depth of filter material-/$`�___�......Total•..•long+h...l.Z. :.:..........:!-.----.-.. "'E Seepage Pit:" Distance to n crest:well"__::::__..._.._:_Distance from-foundation----_-- .Distance to nearest lot line..:.:........... ❑ Number of pits......`..............Lining material...............::.....Size: Diameter_............;_...___.:Depth.:..;__:.... _..:..._:....._ Cesspool: Distance from nearest-Well.................Distance from foundation._:.:........:......Lining material.........:-.-------.------._.------ ... ❑ Size: Diameter......-1---. ........-D.epth....................... .........------:_•c_.Li uicTgapaciry ..---•----•-- gats. 1 ..._......_Distance from nearest bulidin ....... .::........._. Privy:_ Distance from nearest well...._. g•----•-- ❑ -Disfiance`to-nearest lat• --- -•--•- • ----- : - •----•--•-- .--------- __ i -....... -• •°--•--� iine�__.^-•- _ . Remodeling and/or repa3rmg (describe): . !t...... - ........... ---•- ..-•----•---- ---------------------•--...---------:._r r-•--•. ......................................--- •-- .t.1ri l •-----.•--•--•••. , _... 3 ... ........................................t� --------------•••----.. .........................................'---#.. __-t'�' -- r :...._!I I j I hereby certify thatT l-.have 7 prepared this application-and that the•work will•be done Jn accordance with San•Joaquin Counfy ordinances, State laws;aad rules and regulafions of the San Joaquin Local Healfif District. ( r ..----... --•----•.......................... ..........................- ( d/o o ; •---•--�I" Ower an---•-n r C ntractor) By: .........................:(..---...._-----...---........._......_...--------•-------------••--------..._...........tTitle} .......... ' ---•--.....---.--...--•--....... (Plot plan, showing size of.lot; location`of system in relation to wells, buildings, etc., can be-placed on reverse side). , a I '� FOR'DEPARTMENT USE ONLY 1 ( +� ►. . .. ' APPLICATION ACCEPTED BY. ............................-.......................... DATE--3-`'3^t'�......................"•--------•-I REVIEWED BY = DATE-_..... 7------- .................. ...... -•--- _ .. . BUILDING PERMIT ISSUED = `------------------------------------------------= DATE...............: .::.......... ..._........: ..._...... € Alterations and/or recommendations ..... ... ----------•------------•--------.---• ---•---•---.------------.-----.----•-•-----....•----.....!. ... _...__... .----------•---. ----------- ------------ .............. . ............................................. ' –..._........•.... ---"`"--- ........................�. ....._. .. _._ _ _......._.. .....................--.– --- , ---.._- ..... ....- ... ............................................. -----------------------------------------------------------------•---------_..................._....._......:....._ _ ._................................................... FINAL--INSPECTION.,BY:: 1 : --..---_..---•-•--... I 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 y ES-9-2M. Revisaci 1.57 F.P.CO.