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APPLICATION FOR SANITATION PERMIT Permit No. .__!____!_--�:^��.. 1 {Complete in Duplicate] / y ._u. Date Issued Application 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. jJOB ADDRESS AND LOCATION..-_-, 7------Wa�. ------------------------------------------- i Owner's Name-------- ��1----� -- - -�--v------- ---------�--�-----••----- -----------••---- --•-•--------------•--Phone------------------------------------ -- ---•-------- -•-------------•--- •� i Address ' ------------------•---•---------•- ---- Contractor's Name__- -----•---••-•- ��29 ---- --------------- Phone---------------------------------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: _`___- Number of bedrooms_ Number of baths-Z---- Lot size1.1e----_-__--__-•______________ r Water Supply: Public system _Community system E] Private ❑ Depth to Water Table ft. Character of soil to a depth of 3`feet:i Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[n-,-5ardpan ❑ =Lj r Previous Application Made: Yes ❑ No R---�New Construction: Yes �o ❑ FHA/VA: Yes W4—�no ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: �r ' t (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___f�____Distance from foundation__f V________.M,a�/tersal�__ _ r ______-_- [ No. of compartments----�-- Size_x __ :' Liquid depth------ Capacity_._- _-- Disposal Field: Distance from nearest well _____ ____Distgance from foundation------`Q_"_-Distance to nearest lot-line__�.�__.`-.. _ .�... . Number.'of lines________________ _______________ en fli"of each line'_ _ _`s_____.Width of trench____ - - a.__-__________-_ Type of filter,material.f .�Depth of filter rnaterial____i" ________Total length____= �_________________________\ Seepage Distance to nearest well____-' ---------Distance'from fouri• tion--_________':___:.Distance to nearest lot line_________________ �1 p g ' P Number of pits----- ---_-----_-Lining mate Z &ixe: Diameter_'.3 '_'_,.__.Depth____. __Q ---__________ 7 � i Cesspool: eQ amrom nearest well-----------------Distance from foundation--------------____--Lining material------ --- Size: _ -r ._�:�T p 'Distance• _ --------Depth------------------------------- ------Liquid Capacity_ `-------__gals. �~ ❑ m nearest building ----------------- ----------- Distance =---------- Privy: Distance from E earest well-------------------------------------------------Distance from_._______ - Ing-- - --- Distance to nearest lot line-=------- -=------------------- ------------- -•----=----=----- ------------- ----- r 3 + -------- Remodeling and/or repairing (describe): -------- % 4� __ f 4" t -------------------------------------------------------- ----------•-•- -------------------------- ------- _----- --- k ., -- --------------------------------- ------------- -------------------------------------- ----•-------------------------------- I hereby certify that.l have.prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed)._.. `A�10--`__-- ---- - i 1yi - yContractor ) (Title -------------------- - (Plot plan, showing size of lot, locati of system in.relation to wells, buildings, etc., can be placed n.revgge side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- DATE------------------ - Q 1 •t = ------------------------------------•- REVIEWED BY-------------------------------- -•-----�--- --- -- v - DATE--•---- �L-----------------•--•--•-- ---- BUILDING PERMIT ISSUED DATE ------------------------------------------- BUILDING an`d`/or recommendations:---------- c�-c __--,r----- ------ ------------------------------------------------------------ -- ------- ------------------------------• ------------------------------------ - ------ --- -----------------------------•-------------------------- -- =� -•---'5% �t -p---- --- ..52S 7-W------- 0_zA_, --------:4 M,. 1urr�r, �/C ` •�-<c ---------- ------ - --- � � _ '• i ` - -- ------------------ INSPECTION BY:_------- ---- -- -----------------_ Date----- FINAL - -- �. !_Z,�f_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 132 Sycemore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F-P.CO-