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�( APPLICATION FOR SANITATION PERMIT Permit Na. _.JId.:27y (Complete in Duplicate) �zl - Date Issued Application is hereby made. to the San Joaquin Local Health District for a er it to ns u_f and install the work herein described. This application is made in compliance with County Ordi anc� No. 549. & r �� JOB ADDRESS AND LOCATION 'r' - ''t.' = `�Li'►'' Iti_ �fG'k-----ei-K._- Owner's Name--� (lv�c�► •� l--------------------- ----- ----- hone' {J ------------------------ - -- •------------ AID— FAddress------------- ------------- ------------------ --------------------------------------- ContractorsName--------- --------------------------------------------------------------fi�11 --•--- Phone ------------------------ Installation will serve: Resi�denc e Apartment use ❑ Commercial ❑ `Trailer Court ❑ff Motel ❑ rOther ❑. Number of living unifis: ---- Number of bedrooms Number of baths.'=..I.-. Lot size -------------- Water Supply: Public systle�lm�'❑ Community system E]Private Depth to Water Table .w_z_- ft.-• t Character of soil to a depth of 3 feet: Sand ❑ Graver❑ Sandy Loamr❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� Previous Application Made' Yes ❑ No ❑ New Construction. Yes ❑ No'❑' --:FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION' AND SPECIFICATIONS: = (No septic tank or` cesspool permitted if public sewer is available within 200 feet.) 66 1 Se�tic,Tank: Distance #rom nearest well_..._ ----______ Distance from foundation_..., _-...--Material._._ e .-.-it °--------- -- ---- No. of'compartments--__--�----------.Size___A_ e }1-_12.:---Liquidflepth--------------- Capacity...---..---- Dis�osal Field: Distance from nearest well_. 5, -------..Distance from foundation--;►-.i7.-.-_..__-.Distance to nearest lot line ---- I- ..-..._. lil: i 71 Numbe t. of lines ._--__-___�.�---- ---------- Length of each line.. _----- t�_._.__---Width. of french ----I ___._-------- �" Type of'filter malarial.___- .-.__De th of filter material____, _.ji...----.-Total length ......................1_ � P g -%- Seepage Pit: Distanc� to nearest well......................Distance from foundation'..._._.. --.._..__..Distance to nearest lot line ------------- Seepage Number, of pits---------------------- Lining material ----------------------.Size: Diameter ------------------------ Depth -------------------- '-- Cesspool- Distance from nearest well - ----------- ---- Distance from foundation -------------------- Lining material -..--.-.----........______R_._-_----- ❑ Size: DII meter--------------- ------:------------ Depth --------------------- ---`--------------------------Liquid Capacity ----------------------------9 Privy: Distance from nearest well -------------------------------------------------Distance from nearest building ----------------------------------------- ❑ Distance to nearest lot line ----------------------------------------------- -•-------------------------------------------------------------------------------------------- h Remodeling and/or repairing (describe)------------------------------------------------------- - --------------------------------------- -------------------------------------------------------=---------------------------•----------- ----------------------------------------------------------- --------- 'lp :,----------------------------------- - I herebycertify that Illhave 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. Si ned ` , ( g } -------7v' (I 5� ..T/�� (Owner and/or Con+ractork. By: --------------------------------------------------------------------------(r+le}------------------------------------------------------------ (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 M 4 APPLICATIONACCEPTED BY ------- -------------------------------------------------------- DATE --------V-11 \-- ------------------------------ REVIEWEDBY -------------------- ill-------------------------------------------------------------------------------------------------------- DATE----------------- -----------------•----------------------- BUILDINGPERMIT ISSUED---------------------------------------•------------------------------------------------------------- DATE---------------------------------------------------------- Alterations and/or recom �endafions -------- .--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ -------------------•-----------------------------------•--------------------..._..----- jl . i ---------------------------------------------' ---------- r---------------------------------------------------------•------------------------------------r ------------------------------------------------------------- '��67 FINAL INSPECTION BY ------' 4TJAQUIN --------------- -----------'�---- ---- ISALOCAL HEALTH DISTRICT 130 South American St Stockton, California ES -9-21A , Revised l-5-' F.P.CO. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California