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APPLICATION FOR SANITATION PERMIT Permit No. ._t.6_��.U_/_. v (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ti This application is made in compliance with County Ordinance No. 549. " JOB ADDRESS AND LOCATION------- ------�l&lr,a�Yi _4 k ----------------------- Owner's Name - t�"„'----•---- r.�`Za Phone__(_R-.� , �� = , , .1 1 Address ----V, A__- --G C VMck1t�J-------- Contractor's Name---------- ' .= {I4 ?4r' Phone__` 1 Installation will serve: Residence ® Apartment House ❑ Commercial •❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f____ Number of bedrooms __-�__ Number of baths -------- Lot size __J -:"�___________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth fo`Waf&,Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ElClay E] Adobe D--H-ardpan ElPrevious Application Made: Yes ❑ No [E---New Construction: Yes ❑ No D—/FHA/VA: Yes ❑ No ❑ 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_____Distance from foundation__ -------Material_________________________________________________ ❑ No. of compartments------------------- ------Size------------------------•-------Liquid depth-------------------------Capacity-- ------ Disposal Field: Distance from nearest well__ �T__-__-Distance from foundation__?.3 ________:.Distance to nearest lot line____ __________ Number of lines-------/-_--_rj --� --- --------Length of each line----- 6-7" 44AA-_ Width of french--- ��r_�!-------------------- Type of filter material__�Gt`(k<--__-------Depth of filter maferial___-�e_.!_________Total length---I ----------------------------------- Seepage f_________________-____.____ Seepage Pit: Distance fo nearest 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--------------------------------------Depth------------------------------ ---------------------Liquid Capacity-----------------------------gals. a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.------------:------------------.._. l\ Distance to nearest lot tiline_ Remodeling and/or repa eng (describe): { (�� ------ '� --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 an _regulations of the San Joaquin Local Health District. (Signed)__ _____________ ______(Owner and/or Contractor} By:------- --------------- ---------------------------------------------------------------------------------------------------(Title)-------------------------------- - - -- - ------------------- (Plot plan, showing size of lot, location of system in .relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ --------------------------------------------------------------- G' DATE-------'------------ -� ------------------- - - REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------- ---- --------------------------------- BUILDING PERMIT ISSUED-----------------------------------------`---------------�-p-- ------------------------- - DATE Alterations and/or recommendations:__-___t ___Ede+ _._�L�nr, -• }iC- -_ 1 --_--- ----------------------------------------------------•-----------------------------I-------------------- - -----------------------------------._..---... ---• v --------------------------- --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- -----•-------I-------------------•-•----------•--------•------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------•-----------------•-------------------------------------------------------------------------- -------------------------------- 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 , Revised 1.57 F.P.CO.