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e q r( APPLICATION FOR SANITATION PERMIT Permit No......�`1... (Complete in Duplicate) Date Issued .-- This Permit Expires 1 Year From Date Issued ---------i.-___--- Application is hereby made to the San Joaquin Local Health District for a permit # con t uc inst II the work rein described. This application is made. in compliance w h County Ordinance No. 549, sf��' JOB ADDRESS AND LO T N____ '_-1 . r .rr�_.. _i`lf� --------------- r 3 ---------------------------------------',Phone .sil"1 Owner's °Name-- ---------- -5-, --- --- ----- I -- =_ Address-------._�?1f. — -- _... >-------------•-•--------------------------------- f ------------' -------------------------••----------•-----•- r t Contractor's Name ------------------------------- ---------------------------•------------•-------------•---------- Phone ------------------------------•---- Installation will serve: Residence ®, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __./-_ Number of bedrooms&__ Number of baths __/_-- Lot size_Ie2__-7________________________________________ Water Supply: Public system`" Community system [:1 Private F-1Depthto Water Table.- ft. JF Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay, Loam E] Clay El Adobe [A Hardpan I-] Previous Application Made: Yes E]No [!� New Construction: Yes KL No .❑ FHA/VA- Yes ❑ No [L i TYPE OF INSTALLATION. AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu ' sewer is available within 200 feet.) -----Distance .,._ . from nearest well_1_Yfte Distance from foundation-__-/jO_--__.--.Mate ia4---� Wool Septic Tank: Distance f ------------ Sep , �3�, - --------Size'_: Size___. -%k -----Liquid depth ------..I&--- P y--- _ No. of compartments_.-�__.. _______Ca atit t�i.e________._ istance from foundation Distance to nearest lot lyne__4----------- Disposal Field: Distance from nearest well _. -.-._ - - �r �'(-,►----••---- Number of;lines ___._______ -____ _ _ Length of each line______.a_.____________.Width of trench.__ __ ,_ Type of filter material__= -_-Depth of filter -material _________----- Total kength___.__-------------- -------- Seepage Pit: Distance to 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 Capacify ----------------------- • ... -gals. Privy: Distance from nearest well ------------------------------------------------- from nearest building ------------------------------------------ ElDistance to nearest lot line-------------------------------------------------------------------------••--------------------------------------------------- ------------ i Remodeling and/or repairing (describe):------------------------------------------------•--•------------------- ..----------•--------- ---- ------ ---------•-----•--------------------------------------------------------------------------------------•------------------------------ -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------•-----------_- ---------------••---------------- ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- - ---- ----- I hereby certify that I have prepared this application and that Ithe work will be done in accordance with San Joaquin County ordinances, State laws, nd roles and relgulatio o he San Joaquin Local Health District. ! Si ned------------------------------- {O er and�Confracj gY�`-----•---------------------------------------- ---- - --------------------------------------------------- (Title) -------------------------- ------------ --- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a i ,FOR DEPARTMENT USE ONLY APPLICATION -ACCEPTED BY--- --- --------------------------------------------------------------DATE --jam -tP -- �j a REVIEWEDBY -----`---------- °------------------------------- ----------------'---------=----------------- DATE-------- -------------------------------...------------ BUILDING PERMIT ISSUEDa_ y--- .---------------------------------------------------------------- DATE �._ --_ . Alterations nd/or recommen,dations:------------------------------------------------------------------------------------------------- 1- --------- t` ------------------------------------------------ ------------------•-- F --------------------- --------•--------------------------------------------------------- ---------------- ----- - .---..-..-__-_-_--.-_.--_-..'__________________________________________________________________________________________________________________ __ __________________ _ ._______._____.._ 1 ---•--------------------------------------------------- --------- --------- --- ----- ^ i -- FINAL INSPECTION BY: a` Date--.-----�--- - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised V59 F, P, Co.