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A 1-319 APPLICATION FOR -SANITATION PERMIT Permit No. _Z�_7-z-S tv, 00 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District,46r a permit to construct and install the work herein de5cribed' This application is made in compliance with County Orclinarpallo. 549, JOB ADDRESS AND L25 ----- --- -------------------------z------7--------------- Phone------------------------------------ _fION ----- - ------- 01 Owner's Name------- - CIA------r- - ------------- Address------------------------- ---ue ----------------------------------------------------------------------------------------------- --------------- ---------------------------------------- -------- Contractor's Name ------- ------------------- ----------------- Phone----------------------------------- Installation will serve: Residence gr"Apartment House [] Commercial Ej,,I Trailer Court [:] Motel ❑ Other Number of living units: Number of bedrooms Number of baths __/--- Lot size Water Supply: Public system 5K Community system'D Priv616 El Depth to Water Table Character of soil to a depth of 3 feet: Sand [I Gravel F Sandy Loam E] Clay Loam E] Clay E] Adobe 9---Hardpan ❑ Previous Application Made: Ye; El No P<New Construction. Yes �o El FHA/VA; Yes ©�'No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ar'cesspool permitted if public sewer is available within 200 feet.) 1'1� ---------------- Septic Tank: Dstance from nearest well —------Distance orr! found Stion---AV---------- t No, of compartments._.____ ------- Size_ depfh---'7-f----------------Capacity----- � ------ Dispos�a�lId: Distance from nearest well______'----_-_. Distance from foundation----- - --------- Distance to nearest lot line---%--f_ -- Eq Number of lines_____'_-___._-- Length of each line----- - - --------- - ------Width of french----AIV.......... ......... Type of filter material_/_0&6&_Depth of filter maferial----/-?----------Total length------ -------------------------------- Seepage Pit: Distance to nearest well----------------------Distance0"Mfnclafion_,44----44-.Distance to nearest lot line_-__%0___~-___-- Number of pits------/-------------Lining materiaL-.4 ....Size: Diameter_-.,A --- ------------Depth----- ------------------ 'Cesspool: Distance-from,nearest.well-----------------Distance from foundation.-.---_ _-:_-____ Lining material_____________________-.-_-______-_--. ❑ Size: aterial-------------------------------------- Size: Diameter------ ------------------ Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. ----------- Privy: Distance from nearest well---------------- -------------Distance from nearest building....................... ................. ❑ Distance to nearest lot lire--- --------------------------- ell' -- ------ --------------------------- --------------------------------------------------------------------- Oi 7N/ Remodeling and'/or repairing [describe):--------- --------------------------------------------------------------------------- ------------------------ --------------------------------------------------------------------------------------------------- - - ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------1------------------------------------------------------------------------------------------------------------------------•----- ----------------------------•-------. --------------------------------------------------------------------------------------------------------------- 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 Health District. (Signed)----------------------- .......e,,,_, ...... -------------------(9VfF10Z:311:0;ILW Contractor) By: ------------------------------(Title)------4P_T-tj7A ----------------------------------------- ------ rf,�7�---------------------- -- (Plot plan, showing size of lot, location of in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ------------------------------------------------ -- ---------------------------------------- DATE------ -------------------------- REVIEWED BY ------ ---- DATE----------------------------------------------- ------- --- ------------------------------------------ ------- --- BUILDING PERMIT ISSUED.------------------------W ------------------------------•---------------------._ DATE.------- Alterations and/or recommendations:-------- - - -------------------------------------------------------------- -------------�tr • -- ---------------------------------------- --------------- ------ --------------------------------------------------------------------------------------------------------------- --------------- -7 1 �;7 *--------,,o----- ------- -------------------------------- __0---------------- --------------------------------------------------------------------------------------- ------------ ------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------------- FINAL INSPECTION BY:..---A D,t,__---------------------------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oat Street 132 Sycamore Street 814 North "C" Street Stockton,,California Lodi, California Manteca, California Tracy, California ES-9-21x1 ReviseO 1-57 F,P-CO.