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APPLICATION FOR SANITATION PERMIT Permit Complete in Duplicate] " �"• �` _ ? ' Date Issued a �Applica¢ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 3 y -JOB ADDRESS AND LOCATIO -__---------- ---------------- -- -- ------•_--__. r ------------------------------------------------------ Owner's Name------7 _t��--_•. :_--h/ 7/±f�,�_��----------------- ----------- Phone__ Address i� / 74P-6 r�,n s7`�_ � _------ -- ---------------------•----- -•--•-••.---------•--•--------------...---------------•---------------• ------------------------ ----.- -. --�- `3 Contractor'si Name Phone Installetion,4ill serve: Residence A artment House Commercia ❑ 11 p ❑ ❑ Trailer Court ❑ Motel ❑ Other �lv i # f }Numb r of living units: _1---L..Number ofn6edrooms __I._ Number �f baths'--/_._-_ Lot size --------�Q___.�-�'�___________ ______ , _ .., +bpi 1 ' I Water!Supply: Public system"•Community�i ysvem~0 Private L'�epth to ,Water Table ________ ft. ! ��rr t Character o foil to a depth of 3 feet: Sand 0. Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe} Hardpan ❑ Previous Application Made: Yes ❑ N6X flew Construction: Yes�f No ❑ ► � �' TYPE OF li S1 TA-LLATIONh4ND SPECIFICATIONS: ---- r` '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) , 1 Sept ic'T�nkr Distance from nearest well_y?_4_ - Dist�ra fr fou dation__ 6�h__.Material----------------------------- __ -_____. t NO!of compartments_------------------Size_ __.X ___t9_ ---Liquid depth---7` I- � Capacity VIA. Disposal Field: Distance from nearest well'77�--�'_.Distance from foundation_/10_!*_/,�s---.Distance to nearest lot line---_o Number of lines___________3_____________________Length of each line __4`d_�_ ---.Width of trench_.__ -_ _�_________--------- Type ____ T e of filter materia4s 7 ^a. _._Depth of filter material___-.---------!_ � ! 1 Yp � � p -----Total length--------�-------------------------•----- t Seepage Pit: Distance to nearest well----------------------Distance from foundation_______________'____.Distance to nearest lot line_______t_---_-. ❑ ,. Number of pits.-------------- Lining,material------------------I----Size: Diameter_..__ --------:-------.Depth--------------- --_.._!_4_.... Cesspool: r Distance from nearest well_________________Distance from foundation-------------------- Lining material__.-___-______________________:__ ❑ Size: Diameter---- --------------------------------------Depth',! -------------)-------------- - -------k---Liquid Capacity----------------------------gals. Privy: c Distance from nearest well---- _b.._____ _________.,_ t_-_ - J { - -� - � :_ ----- _ -�-Qistance from nearest building "Distance to nearest lot line --- -- "" ----` - �' ►- �� 4 __________________________________________ Remodeling -and/or repairing'(describe)-------- -------- ------------------ \ _�_ _-_7 --4'_,, A---------------•-•------ .._..- I- -------------------- ------------- t ; --- - --------•-•-• --- -------------------•-------•------------------------------- 1 - -------R------------------------------• '1, I f It { � 9 --------- -- t�----...-- ---- --••-•-----------------•---•--•--------- I -------•-------------------------- --------------------- -----------=----=-----------------------------------•----- 1'hereby certify that-I have preparedthis application and that the work will be done in accordance with San Joaquin County ordinances, State laws,9and rules and regulations of the San Joaquin Local Health District. (Signed)--- i - ----------------------------------------------------- 1# - ------- --------------- -- --(Own ) y:.---------------------=------------- -------------- ---------------------------------------------------- •---------------------(Title)--I-=----------------------------------------- --------------- (Plot plan;i.showing size'of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). . f I } FOR DEPARTMENT USE,ON Y APPLICATION ACCEPTED BY -1i1a DATEV REVIEWED BY------------------------=------------=-------- - " -- ------- DATE BUILDING' -- ------- -------••----•---- •--�-- PERMITJSSU.EDy�------_-_- --.f - ----------- DATE Alteraiions and/or recommendations:__._ _w-- --_-:--------------------------- - E -� - --- ------------- --- - ------- --- -- ------------------------ti ------------------'------------------ I ----------- ---------------------- -•------------ -----•----------- ----------------------------------------------------- 1 - ----- F .. - 77 � � FINAL-INSPECTION BY "F------ ----- ---- -� riM_..--------------------- Date". : ................:..-�.----�---• -----'--��-------------SAN JOAQUIN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 West Oak Street !t 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca California Tracy, California ES-9-2M : Revised W-2100' �,