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Permit No, - ---- -- xis APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ----la-71- -J:3 work herein described.A gp4otafion,i;�hereby made to the San Joaquin Local Health District for a permit to construct and insfafl the w Is application is made in compliance with County Ordinance Y 0. 54)9 el;l- V --------- ---------------14�-------------------------------------------- JOB ADDRESS AND-LO - ----- ------ -- _2AT TION ------------ -------- Phone-------------------- ---------------- Owner's Name-------------VAF_10��L ------------All- / Z A ------!•----- ----A--------------t 01 Address---------------- -----/- I , -W W Phone------ Contractor's Name:__________ -- ---- ----- -- -- - ------- - Other El Apartment House El Commercial El Trailer Court Motel [3 1 Installation will serve: Residence 15"1110101---------- rooms I_ Number of Lot size --------aae�j ------- Number of living units: _/---- Number of bed a er TabAI(27ft. Water Supply: Public system 0 community system 0 . Private e�__f �d _�Favel El Sandy Loam El Clay Loam El Clay E] Adobe P--'Hardpan El Character of soil to a depth of 3 feet: San Previous Application Made: Yes ❑0 No *0' Now Construction. Yes jl�No E) i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f - Material_�__ --------------4- -i foundation----/A---------- ---------- Distance ro nearest well Septic Distance from r - - ------Capacity_ ------------- ------Liquid depth- No. of compartments----- - ----------------S;ze---- loun6atio nearest well-—----—----- ---d------Distance to nearest lot lin Distance from n Distance from - 0 Width of french------ ---- -------------- '141114 Disposal Field: Length of each line____-_;9 ..... ----- Number of lines_ ---------- th------✓ -- -------------------- Depth of fil te r material---- Total leng Type of filter materia�__/_G__ _-_ e----------------- 11�6 Seepage Pit: Distance to nearest well-------------- Distance from foundation--------------------Distance to nearest lot lin Number of pits----------------------Lining material-----------------------Size: Diameter____--_________---__---.Depth--------------------------------- ❑ Distance from foundation __.Lining material____-"_______-"_---------------------- Cesspool: Distance from nearest well_________________Distance ---------gals. Size� Diameter----------------I----------------------Depth--------------------------------------------------------Liquid-Capacity------------------ ❑ ----------------------------------------- PriWy_:-` Dista-'nce from nearest well____________------------------------------------Distance from nearest building - ----------------------------- - ------------------------------------------------------ ------- ❑ Distance to nearest tot line______._________________________ 'r+! -- ----------- ---- -------------- --- -------/ _ Remodeling and/or repairing- (describe):--------------- -- - --- -- - ----- ---------!1_1------ --------------------------------------- ------------------- :------------------------------- ------------------------------------------------------- -- ---------------I------ ------------------------------------I-------I------- ------------------------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------I-------- --------- - ------- --------- - ------- ------ --------- - --------I hereby__certify that I-have prepared t-his-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 H alth District. ._"__{Owner n d or Cqn1ractorl ---- --------, (Signed)--------- By:------- ------------------jTitle)----- -- --------- --------- ---------- (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE:::g------------------------------------------------------ APPLICATION ACCEPTED BY- -----r----------------- ------------------ _V------------------------- ---- --- DATE -------------------------•------------------------- REVIEWEDBY---------------- ----------- ---- ---- ------------------------------------ -------------------- DATE-- --:10------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- ---------------------- Altwations and/or recommendations:____"____-___"---- -------------- --------- ----- --------- erations -------_i_------------ -- --------- ----------- --------------------------------------------------------------- ------------------------------------------------------------------------------------ ----------------------- -------------------------------------------- ------------------------------------------- ------------------------------------------------------------ ---------------------------------------------------------------------------------- ------------------------------------------------------- --------- --------- --------------------------------------- -------- --------------------------- ---------------------------------------------------------------------------------------------------------------- -------- 2-- -------------------------------- -------- FINAL INSPECTION BY:---------r-` --------------------------- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C"'Street 130 South American Street ,Lodi, California Manteca. California Tracy, California Stockton, California ES-9-2M B-51 Revised W,,=