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e Ll, 11 I APPLICATION FOR SANITATION PERMIT Permit No. .93��__ (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. This application is made in compliance with County Ordinance >"1549 - 1 JOB ADDRESS AND L ATION- -----7,?�- -4------------- - -----------. _.:-.------------------------------------------------------------------•---- Owner's Name - r °" { _ Phone Address -•-------•--------•--------------------------------------------------- -- -------------------------- ----------- - Contractor's Name------- ------------ - L'✓ILA--�---------- r------ Phone ---- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f�_-_ Number of bedrooms _- ' Number of baths ---Z_ Lot size .----'10 _0------- -__-.___.__ Water Supply: Public system 8�Commbnity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 21"H rdpan ❑ Previous Application Made: Yes ❑ No [P`�_New Construction: Yes ❑ No R9---=HA/VA: Yes ❑ No E5'' TYPE,OF INSTALLATION AND SPECIFICATIONS: '(No septic tank or'cesspool permitted if public sewer is available within 200 et.) epic pk: Distance from nearest well-----------------Distance from foundation--------------------Material--------------------- _-.-.-__.-.-.-._------- No.,of compartments-------------------------Size--------------------------------Liquid depth---------------------------Capacity------------------------ I ---------------------- f Dis oral Fi Id: Distance from nearest well-__` ---.-.Distance from foundation _' Distance to nearest lot line___'---��_-- f- Number of lines___-,�_._______'"_--_-_- ------ Length th of each line____ Width of trench__- ...........________ g ---p---�d<----- 1 Type of filter material_/,_ _-___-_ _Depth of filter material__Zd______--------Total length------. -419------------------------ Seepage Pit: Distance to nearest we11_"__-----"`_____Distance f�m oun tion___ •�� ____.__.Dist ce to nearest to line____ ____: [(� Number of pits._.I___.I_ _;,`_____Lining ,material-I�' ize: Diameter_; -----------Depth____ -__.___... - Casspoal: Distance from nearest well-----------------Distance from foundation....................Lining mater4---------------------_--______-._---_ ►I"' ❑ Size: Diameter-------I------------------ ----------Depth----------------------------- ----------------------Liquid Capacity----------------------......gals. Privy: Distance from nearest viell-------`--------------------------------------------Distance from nearest building------------------------------------------ a i ❑ Distance to nearest lot line.- _ ----- .. ------------------------------------------------------------ Remodeling and/or repairing (descrii�e): ------ -------- +_ ._.� - � � -----------------------•------------------------- --------------------------------------- ------------ :---------- ------------------------- ----------- -----•------------------------------------------------- VA ---------------------------•-------------•----------------------- -----------------•-•------------------------------------------------------------------------------------------------------------------------------- -------------------------------- ------- --------------------------------------••------------------•----------------•----------------------------- --- - --------------------------------- 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 and regulations of the San Joaquin Local Ijealth District. (Signed) 0 ---- --�� _` --------------- ----------- BY: --------- -- - (Titley f t ' (Piot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse e). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY-----------° ------ -- `` -------------------------------------------------------- DATE---------- l� • t�' I REVIEWED BY-------------------------------------- DATE--------- f ------------- BUILDING PERMIT ISSUED-------------------- -`.' -------- -- ---.- DATE-------------------------- Alterations and/or recommendations:----------- --------------------- ---------------------------------------•--.------------------------------------------------------------------- -------------------------------------------- ------ __. - ----- - --------------------------------------------------------------------------- ---------------------------------- -----------------------=------------------ F]NAL INSPECTION Date--------1------- ------- --(----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sauth American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--21x1 Ravisea 1•57 F.P,CO. ,