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tJ7 �� APPLICATION FOR SANITATION PERMIT Permit No. .�.� �.g` ..... "t (Complete in Duplicate) ,Z ,$� (d This Permit Expires 1 Year From Date Issued bate Issued d _____ __________ _ 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 No. 549. 5 ,p ! JOB ADDRESS AND OCATION------------i , JV I Owner's Name--------- - �' ------ P one----•---------------------------•--- --------------------------- � --- --- ---- - - ------ - ------- --- Contractor s Name----------------"� ------- - -~--------------------------- -•------------------------------------------ ne. 0'--G/- Pho Installation will serve: Residence ❑'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___ KLdmber of bedrooms __1___ Number of baths _l-__ Lot size -------6_Q---.�--- -10------------------------ Water Supply: Public system Community system El Private epth to Water Table !v7 + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobear an ❑ Previous Application Made: Yes ❑ No New Construction: Yes p No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P , foundation--------------------Material-------------- --------------------- ----------- p _ -- ;-- ------Liquid depth--------------------------Capacity----` ---------------- Se tic T Distance from nearest well________________Distance from Dis osa field: Distance from rnearest well._6Q______.._.D stance from f { poundation_,l_0..t_______-.bistance to nearest lot line___ 1_._____ Number of lines--------- I---------------------Length of each line-------1-a---1------------Width of french-._ - -- - --.----.----------- Type of filter material'Y84-X_______Depth of filter material -_k_9_ ___________Total length_________5 jo 6� .� Seepage Pit: Distance to nearest well------_-------------__Distance fro m foundation------------f-------Distance to'nearest lot line---------------- ❑ Number of pits------------------- --Lining material-----_-----------------Size: Diameter-----------------------Depth--------------------- :--------- Cesspool: 'Distance from nearest ;well-----------------Distance from foundation.-------------------Lining material___________________________________ i El Diameter-------------=--------------- --------Depfh------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest'well---------------------------------- _-------------Distance from nearest building.-------------------------------------- ❑ Distance to nearest lot line------------------------------------------------•------------------------------------------------------------------------------------------- i Remodeling Ind/or repairing (describe):--------------------------- -• -----�07 - ------- r ' `�'�- ------ ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, a les and reg ons of the Sa oaquin Local4HethDistrict. _. �'4 - -----------'."-"`�-�!- `l (Owner and/or Contractor) (Signed) BY ----- ------ --------------------------- {Title) Q '! (Plot plan, showing si a �Icatiion, of system in relation fo-wetls, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------- DATE ~---------------------------------------- REVIEWED ------ ---'----------------REVIEWED BY--------------------------------------------- ---------- ---------------------------------------------------------------.... DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------- -------------------------------•------------------------------------------------------- �- .r _ ------------------------------------------------------------------------------------- ------ ----------------------------------------- --------- ---------------- --------------------------------------------------------------------------------- F -------------- --------------------- ----------------------------------------------------------------------------- �--------- � Ao i FINAL INSPECTION BY: ---- - - - � Dater- -- --- - =-'_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-92M Rev[sed 8-'S9 F.P-Co.