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Permit No (Complete in Duplicate) APPLICATION FOR SANITATION PERMIT Date Issued ------ This Permit Expires 1 Year From 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 No. 549. 4 , 1_ __L14——-------------------------------------•------------•--------•-- - -----------------AND LOCXTION, -- - ----------------- ------------------------- Owner's Name----- le ------- --------------------------------- -------- -- Address-----------Aql --- 13 - � ----------------------------------------------- ----------- Phone-------------------------•- Contractor's ------- Phone----_---_------------------- - Installation will serve: Residence jkj Apartment House rl Commercial [:I Trailer Court E] Motel 0 Other [I Number of living units: J----- Number of bedrooms -3--- Number of baths 1-_ Lot size ---- --------------------------------- Water Supply: Public system [3 Community system El Private X Depth to Water Table-j-'0-- ff. Character of soil to a depth of 3 feet: Sand E] Gravel 171 Sandy Loam [M Clay Loam E] Clay E] Adobe C] Hardpan E] Previous Application Made: Yes F] No A New Construction: Yes No E] FHA/VA: Yes 0 No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availa'bl6 within 200 feet.) 4f from foundation---- 0 Sept;c Tank: Distanca from nearest well-_15,9--------Distancp --------____.Material____ --------------------- h I -------------Capacity..-.1 No. of comparfmenfs_____,,�., ----------------Size,4 :t Liquid clep� -------- Distance to nearest lot Disposal Field: Distance from nearest welI_X0.'.___Distance from foundation------------------- 'y -- ------------ 3 Length of each line------Yck Width of trench_� Number of lines--------------- ----- feria'I-----IF 10------- ----X4--------------------! "'a -------- -Total length Type of filter materia ----.Depth of filterrn - ---------Distance to nearest lot line_ -__._•Pit: Distance to nearest wef Seepage ----------Distance from foundafio ng maferial*&,� ---------- Number of plts.------------------------Uni _:__ Size: Diameter__!�Z�_.__..-------Depth----, -- Cesspool: ..Distance from nearest well-----------------Distance from foundation.___.---- ---------Lining material---------------- RSize: Diameter---------------------------- ---------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well--------------------------------------------....Disfance from nearest building--_.___________--------_-------- ------- ❑ ------------------------------------------------ Distance uilding----------------------------------------0Distance to nearest ]of line________________.__.___ ------------------------------------------------------ ------------------------------------------------- Remode4lng and/or repairing (describe):------- ---------------------------------------------------------------------------------------- ------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ------------------------------------ -----------------------------------------------------------------------------------------------I--------------I----------------------------- ------------------------------ - -------I----- ------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. : :-----------------------------------------(Owner and/or Contractor) (Signed. ---------------------------------------------------------------(Title)------------------------------------------- ----------- - By:-------------------------------------------------- (Plot plan, showing size of lot, location of system in'relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -------------- DATE.,,f-:,eXY---------------------------------------- & - ------------------------------------------ APPLICATION ACCEPTED B(__ '4 4V -_ DATE----- .--------------------------------- ----------------- REVIEWEDBY----------------------------------------------- --------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-----------------=--------------------------------------------------------------------- Alterations and/or recommendations:___.________________----j------ -----I------------ ---------------------- ---------------------------------------------------------------------- ------- ---- ----------------------------------------------- ------ ------------------------------------ ------------------------------I-------------------------------------------------------- ---------- ------------------------ e_ ---------------------------- -------------------------------------- ---------------------- -----------------1_:---------------------I---------�------------------------------------------ ----------------------------------- .11, - il ------------ -------------------------------------- - - -----------------_-------------------------------------------------------- ---------------------------- -------------- ------------------ ------------------------ ------- ------------ ------ ---------------------------- ------------------------------ ----------- ---------------- ------- - _ �- --------- ----------- Dat ----------------- ------------- ----------------------------- FINAL INSPECTION BY:__4�"_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore SfrOG+ 814 North "C" Street CaliforniaStockton, California Lodi, California Manteca, California Tracy, Californ; ES-9-2m Revised V59 F.P.Co.