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i r APPLICATION FOR SANITATION PERMIT Permit No. ...1 .._ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .---/�-- -_C Application is hereby made to the'San Joaquin'%ocal Health District for a permit to construct and install theZwhZe/iinescr)ped. This application is made in compliance with Cour4y Ordinance No.rS�49. JOB ADDRESS ND.LO ION------ 1.1-t�4. � " 04&R* ------ C _ Owner's Name F'i ----- . � �� e--------K cLae---- ----------- Phone---------A-jQf's-� Address. " _. , -� Contractor's Name-- ------•--- -#Tfrtl ---- ----@.- ----------------- -------------------- Phone-----------�---------- ------------------------ Installation will serve: Resi ence;4Apartment House E] Commercial El Trailer Court El Motel E] Other ❑ Number of living units: _� Number of bedrooms _--____ Number of baths ___ Lot size _-------- Or_ t ___t -Q--------------------- Water - -„p„_n.•{..,;+..� rs - Supply: PublOsystern Communifi system � `""'�'""-,•.. � y y ❑ Private ❑ Depth to Water Table _.�---.- f}. r Character of soil to a depth of 3 feet: Sand [❑ Gravel [] Sandy Loam ClayLoam Clay❑ y ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No'� New Construction: Yes No ❑ FHA/VA: Yes ❑ No`� TYPE OF INSTALLATION AND SPECIFICATIONS: "" =r (No septic tankfor cesspool permitted if public s ew er is available within 200 fee+.)w_ cv, �_....^...,..�..•.. ion - Materi I------ 0--� ;-- ---- ------ --- Septic Tank: i7istance from nearest well---ss-�'� :-____JDistanc� from efounda�tion-�(�l-/�-_ . � + Noll of compartments--'---------- ------------ Size--T_-�-_g_tC�----Liquid dept -----�- ---t Capacity_ t Disposal Field: Distance from nearest weft_ ..-- ...Distance from foundation}&IVt,_tO_l_.Distanae�fo'nearest lot line--- Nu M"ber of lines----------------�-----�----lLengtn of each line------Et-4�-t�_--�---Width of trench------pl----_________--_-- - Typ of {filter materia!-6,__l d ._ ep}h of filter material'--►_f$_-_____1--Total lengthA-----IR-Q--------_ ------ '_ Seepage Pit: Distance nte }o.n,e_a�_est we L_ - F---L � L _______[Distance to ne�arest, lot line_-------------- ---- istance fromjounclatibn-________❑ t IurAiber of. its.._--- _.._._. Linin material-____--� `--'__ Size: Diameter- s y'sf .• w P •r. -,. r5t1:9 R j .�,Depth_ ------------------- Cesspool: Distance from nearbsfi Weill._. -_ _-- 'Distance from foundation- _.Linin a}eriah "�- . --------- - -------------� _r •#------------------------------ l Size Diamete ------------- El -:a--- e th---------- �-------- ---- ----- *-Liqui � p .--:Y---------- ---------------gals. � d Ca acct Privy: Distance from . ea rest.well --- _ -- ----------- -- _ -- Distance from narest;building __------------ Distance to nearest lit line--------------=`=� y, .r , .1 A k 4 g t---- - ----------------------------------------- Remodelingand/or re irin des tt3 b (� - y - 1.1q ..$ �'{- ---------------------------------- ----• -- --------- ------------- -------------------------------- �ca�c ----- i, r - -;r --------------------------- -- ----------- -- } -- ------------------------------I------- i - - tF;r- `° I Y Y L preparedy - - ------------- ----- '-- --•------------------ I hereby certify than f ha a this application,,and-+hat the work wiN be done"inlaccordance with San Joaquin County ordinances, State-laws, and�ru et and reg lations of,.the;.t'an Joaquin Local Health District. ' (Signed)------- " ---------------------------- --------IOwier and/or Contractor) r _ Plot Ian, showing size of lot, locatiion of sys+em in +o wells, buildings, etc., can be on revers P 9 _ - _ j P � side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ ______ _____ _ --- ---- -------------------•-------------..- DATE------------ REVIEWED BY--------------- t G -•- .I r - ----------------------------------------------------- BUILDING PERMIT ISSD----------- - ------------------ ----------------------------------------------- ---------- - DATE w - ---------------------------------- ------------------------------------- Alterations and/or veto menda4ions:_. .,� ��•-ww• ------------------------------------- ---- --- -- ---a ---------------------------------------------------- ------- ------ ---------- ---------------------------------- 4 �-/7 - lam/ FINAL INSPECTION BY----- --------------------------------- - ^ �„� `�p / Date- SAN JOAQUIN LOCAL HEALTH DISTRICT UO South American Street 300 West Oak Street 132 Sycamore Streot 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.