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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / 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. JOB ADDRESS AV OCAT �•-:'� -------- -r----------- - ------- ------ a--- -------- -------------- ------------ -------- Owner's Name - Phone Z-es6w------ Address------------------------ - , -------------------- Contractor's Name--- o - f u-f -- � a FK[ • Phone- -1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units:Qy7,L-Number of bedrooms �G W/t Number of baths _ __. Lot size _ 9i�-_ _�• . _______________ Water Supply: Public system ❑ Community system fl Private 9 Depth to Water Table-tT ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ir`'l Hardpan ❑ Previous Application Made: Yes ❑ No X, New Construction: 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 well_________________Distance from foundation--------------------Material------------------------------------------------- Disposal Field: Dim isstance frorenearest _ well- _______________D stance from foundation -- --- depth Distance to nearest est lot lineNi F-1Numberof lines-----------------------------------Length of each line------------------------------Width of trench.----.------------------- - ; Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ t J 6 Seeps e Pit: Distance to nearest welLJ-7-_________.._Distance from foundation-_,/------------Distance to nearest lot lip e__ ______ --- 14 Number of pits__AlVf_-------Lining material----RK4.0'(,,-Size: Diameter-----3.3-----------Depth-- --- --------------------- Cesspool: Distance from nearest welL_______________Distance from foundation--------------------Lining material-------------_--_____-__--__-_____. ❑ Size: Diameter--------------------------------------Depth-----------•----------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well_-_______---------------_-.______-_ Privy: � __________Distance_from nearest building__________________________________________ ❑ Distance to nearest lot line- ------- ------------------------------------------------------------------------------------------------------------------ ---• --- ---- Remodeling and/or epairin describe):______ _ __.___-7 a..-____ - _____________________ ------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify, that I have pre d this applica ion and fhat the wor ill be done in accordance with San Joaquin County ordinances, Stat ws, rules a d r gulations of a San JoaquinZLoc 'Xealth District. (Signed) 411.- -ti_---- --- 1 - ---x----------- �!------------(Owner nd/or Contractor) sY= .. ------ t ------------------------------(Title)-- r ------------------ (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be pla on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- DATE----% ------------------------------------------------- REVIEWED BY--------------------------------� .---- DATE--- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- '2i Altera 'ons and/or recommendations------------------------ --------------------------------------------------------------------------------------------------------------------------------------- -------1-------------- ------------------ --- -- ------------- ------------- ---------- ------------------ - - - - -- ----- -------------- - r --- . ---/ ".- -------- `� .Q _ "*'c ------------ - ------ ------- '------- - _ -r------- ------------ - --- - ---- --- - ------------------ ------ --------- ------------- - -- ---------------- --- -- --- r� - t --- - WFINAL INSPECTION BY----------------- - ----_------- Date-----------------�- - - 5' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 West Oak.Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100