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Al kxl� ,pr . APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 0 Date Issued -------;A7/_e6 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. JOB ADDRESS A CATION � � t T .. � kG- � ------------ --------------------- Owner's Name s ---� -------- ----------------------------------------- Phone Zo �J LL" A Addressn-- cQ'E 0 -••------------------ -------------------------------__------•-------------- ` = Contractor's Name-----�ihR ..�. -f-�`11L �__I_ S�?.-i� '--------- ------------------------------------------- Phone �{� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �jf - ---------------- Number of living units: _1____ � umber of bedrooms tai.___ Number of baths _I___ Lot size __ ,�--_.- � Water Supply: Public system ;I� umber system [__1 Private ❑ Depth to Water Tablev.3.4?_ ft. Character of soil to a depth of 3 feet: Sand Gravel F1 Sandy Loam E] Clay Loam El Clay E] Ad �ardpan ❑ .Previous Application Made: Yes ❑ No New Construction: Yes 2"'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wrel�l.OQR�-----Distance from foundation-1-0-41--- -___.Material----��- ----L = ---- No. of compartments....Ga----------E+_-------Size.__�_. �___-----Liquid depth_od7�___----- ---Capacity__ P__Q �>s, Disposal Field: Distance from nearest well-ko_R. --Distance trom foundation_9!Q_____..'___.Distance to nearest lot line__lsff p .¢ _1 - Number of lines-----I--- ---------------------Length of each line---f pWidth of french of filter materiai��c__Rk--_Depth of filter mater ial----Z_ ...........Total length---------- __'_________�_ -,-- Seepage Pit: Distance to nearest weli_tEone_:--_ ---Distance from foundation---1-(-8__-.___.Distance to nearest lot line_________________ \ Number of pits._-.t-----------------Lining material--_RQGk------Size: Diameter---, -�,...---.Dept h....-�-Q`__._............ fn I :esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.--.-_-----------.-----__-_____--_. ` ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------.-Liquid Capacity----------------------------gals. I Privy: Distance from nearest well---- --------------------------------------------Distance from nearest building.______.-__---.__-----..___________-_-.-. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- ----------------------- l Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------:-•--------------- ----------------------------------------------- --------------------•-----------------------------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accord ance,with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. - /s �`_x ---------------------------- r Contractor) rr (Signed)..------A ----- 1 frL°-' o $ ---------------------------- ------(Title)-------------------- - ---- ------------------------------- (Plot plan, showing size of lot, location of system in rela n to wells, bui m s, etc., can be laced an reverse side). 40 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "] jA "------------ -------------------------------------------------------- DATE-----1V "MR,- ------------------------ 1 REVIEWED BY-------------=------------------------ --------------- ----------------- -- -- --------- ----------------------------- DATE------------ _..------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•—-------------------------------------- DATE------------------------------------------------------------ =and -------------------------- ---------------------------------------------------------------- Alteratio /or recommend ions'- --------------- - ------------------ - - ---r-- ---- ------------------------- ` ---------- ---------------------------------------------•----------------------------------------------------------------------------- -- --- ---------- ---------------------------------- ' FINAL INSPECTI Dateu- T � --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F-P.Co. a