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1 APPLICATION FOR SANITATION PERMIT Permit No. _31. (Complete in Duplicate) Date Issued ______ / Applica+ion is hereby made•ito the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance.wifh County Ordinance No. S49. ?4 l 041 - MoD-SZ JOB ADDRESS AND LOCATION_.:___ ':- - __ r - Owners Name----- Fr - �.---•-•-•----•-------------- ----- -------------------------------- Phan ---- ` : .. Address.............. =---•--------- ------------- -•---•-----------------------------------••--_..._..._.... Contractor's Name `• -- - - . �- '. 'wt - Phone_ fI _ ---- Installation will serve: Residence (Apartment House .❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living uni+s: _ __- Number of bedrooms • -. Number of baths __ __ Lot size ___ ilD _. ' "_________________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table- ft. Ilf Character of soil to a depth':of 3 feet: Sand ❑ Gravel p Sandy Loam [3 Clay,Loam E] Clay ❑ Adobe &."Rard an P E]t Previous Application Made: Yes ❑ No ( New Construction: Yes rq`No ❑µ TYPE OF INSTALLATION AND 5PEClFICATlONS: = (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Tank: Distance from nearest well_)T-07��istance from foundation----1+e--------Material---�-�_ ------ ---------- No. of compartments___Q-___.___.___._.__Size. _ ___! �___.Liquid depth._-- - Capacity__ ___ I. r �,- -------- `Disposal Field: Distance from nearest well_) ^Distance from foundation-2Z___ _.Distance to nearest lot line---4ARVP _..__. Number f lines.__.__ Len th of .each line_._ ` i .' �- ------ ---- ---------- -- g �---- - fn/'dth of french.---- type rench-- - �-----------------••-- Type of filter material- __ ______________Depth of filter material-___. .............__. otal length__/Jt_0 ..______________.�.._ Seep Pit: Distance�to nearest �� - `" __Distance from foundation_ nce to nearest lot {ine._ ______.__ Number sof pits,--- "L-inirig''m _ ___ _ ,." _aterialSize: Diamete ._-__ --------Depthu*qP __ . _________ i Ces ool: Distance;�rom nearest well-----------------Distance from foundation. ---__Lining material_-___-___________.__..____-__..___. Priv Distance) ater-- -. pth---- Liquid Capacity --------gals. ❑ Size: Dia y: from nearest well _________________Distance from nearest building______.._____________..._______._.______. ❑ Distance to nearest'lot"line__'___--------------------" f - -------------•--------------•---------------- Remodeling and/or repairing (describe):______.._ �� -- ��_� .•Z �� - rt -. lam' r -- .;- ------ I hereby certify that I h�ve'prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and les and regulations of the San Joaquin Local Health District. Si had �.:�_- � /4 ---------------------- --------------------------------- -----------=--------- { 9 . II!! ...-.,` ______________ ----------------(Owner and/or Contractor ----------- By:. ------ 7- ----- -(Title)_ .. ------, (Plot plan, showing size of loll tl cation of system in relation to wells,buildings, etc., can be placed reverse, e). .M � FOR DEPARTMENT USE ONLY I i1 APPLICATION ACCEPTED BY--- _ - DATE - REVIEWED BY-------- -- ------ ---- - DATE-------- ------ - -- BUILDING PERMIT ISSUED------------------------- ------ ----------- -------------------------------------------•------ DATE---- -------- ------- 4fc/ Alterations and/or recommedations:-------------- --- - ------------------------" --------------------------------------------------------• ------- ----- ------------------------------------------------ ------------------------------------------------- ------------------- ---------- li ifi -------------------------------- '�- -------------------------------------------------------- ---------------------------------------------•----------- FINAL INSPECTION BY:_..... -- - --• --- --------------------------- Date------- J --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stteet 132 Sycamore Street- 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWODO