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APPLICATION FOR SANITATION PERMIT Permit No..11.,._-d . [Complete in Duplicate] / Date Issued ___(�� This permit;Ex fres 1 Year From Date Issued , ------ Application is hereby made to the San Joaquin Locai 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 AND LOCATION_/Ar___/f/P*1 /Ar ..... �51��1 Aip4,4 i_ _...---•-•--- /—,0& 0, Owner's Name ---------- &,1�-zl:c ------------------- ---------------------------------------- Phone ----------••------------------- - Address------------ -----------0114 -----W---/MAIA�a------------ Contractor's Name--------------------- 7,�.._-_ ¢- �'`----------------------------------------------- -----. Phone.--•-------------- - ............... Installation will serve: Residence Imo- Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel. [] Other ❑ Number of living units: ___o__ Number of bedrooms ______._ Number of baths A__ Lot size _./."e.-••_" Water Supply: Public system � I Pp y� y ❑ Community system Private ❑ Depth to Water Table %�- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @--Flardpan ❑ y�' Previous Application Made: Yes ❑ No 9?*" New Construction: Yes &' No ❑ FHA/VA: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank; Distance from nearest well ------ -'+•__-_Distan/�ore__.__ /e__.-_- ----- ------,Distance from foundationMaterialt�"-�__..�° /��- No. of compartments_. ---- &----------- Size_calr/l�_'__,x_y©----- _Liquid depth"".__m _..__.Capacity__%C Disposal Field: Distance from nearest well._._—____._Distance from foundation-___ AQ-----__.Distance-to nearest lot lin--e--_-� f----fu .-__ -_Len Length of each line____ �- ------ - Width of trench Fi---------------TYPe of fter materiaf�- pepth of filter material ---- le a ----- Total length______ at_ - --------------------- Seepage ____________ _""_._Seepage Pit: Distance to nearest well ---------------------- Distance from foundatio"n_______..__________.Distance to nearest lot line_ I ❑ Number of pits ---------------------- Lining material ------------------- ._-Size: Diameter --------- -------------- Depth I Cesspool:Distance from nearest well ----------------- from foundation--------------------Lin-ing material- --__--_--_-____._ ----------------- ❑ Size: Diameter -------------------------------------- Depth --------------------------- ------------------------- Liquid Capacity--------------------------. gals. Privy: Distance from nearest well ----- -------------------------------------------- Distance from nearest building ❑ Distance to nearest lot line --.----- -____.___-___!____._____ --------------------------------------- Remodeling and/or repairing (describe):.t ------------- - - -j -,_.-_ , ifs -----------------------------------•----------------------------------- ----------------- -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------------------------------------- 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. (Signed)------------------------------- �r,� r Contractor) By: ,A ------ �----------------------- (Title} l a------ --------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 1679placed on revel side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-___7F,_P_- --------------------------------------------- REVIEWED ----------------------------------------"-REVIEWED BY - --------------------------------------------------------------------- BUILDING PERMIT ISSUES ---------- Alterations and/or recommendafions :_---_-____-----------------___._-_ ---. ----------------------- ------------------------- DATE--------- -------------------------- DATE ------------------------- DATE------- --- -------------------------------------------------------------- ------------- ------------------------------- FINAL INSPECTlO BY:�-------------- Date--- - -------- SAN ------ 130 South American Street Stockton, California SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Sfree! Lodi, California Manteca, California FS -9-2M Revised 8-'S9 r.P.Co.��;' 814 :~forth "C" Street Tracy, California