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fl"A-0 APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) This Permit Expires 1.Year From Date Issued 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. S49. JOB ADDRESSD LOCAT�ION--•_-- ��'�' Owner's Name_3--c-ii,, a----------j_.__0d____----�Y_—Eje Address----------------- t-------------------- --- •---•• Contractor's Name----- --IA-1 IA-16---------- �Is---------------------------------------------------------------------------------------------------- Phone,/ -------------- Installation will serve: Residence [j"_Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ____L_ Number of baths -1----- Lot size --A AV�_ Water Supply: Public system ❑ Community system ❑ Private [6— Depth to Water Table _J�;? ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E�- "Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No 0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is'available within 200 feet.) r 1. Septic Tank: Distance from nearest well---P-------Distance fromO e_d4v00d _ _ ---d--am--------------- No. of compartments--------;2 -------------Size...._.X ------------Liquid depth----k_------:---------Capacity--$ ��.. Disposal Field: Distance from nearest well_,Xa-�____Distance from foundation...7_-----------Distance to nearest lot ........... ®— Number of lines-------------1--------------------Length of each line----------- ------------Width of trench--------_r�__y__y--------------- Type of filter mate ria€____�oA_�__-___Depth of filter material-___./__1-_"-__--- Total length------... -__ -- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line__-___ -_--.-_--- [❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------- --.--:-----Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----__--------------Lining material_______._..__..____.____.____-._._._ ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. („ Privy: Distance from nearest well------------------------------------------------- from nearest building--._______._____________-___-____.___. ❑ Distance to nearest lot Line -------------------------------------------------------------------- ------------------------------------------------------------ Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------- ------------------------------------------------------------------ N ---------------------------------------------------•---------------------------------------------------•--------------------------------------------------------------------------------------------------------------------- ------------------------ ------------------------------------•--------------------------------------------- ------------------------------------------------------------------------------------------------------------------ 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 ru s and regulations of the San Joaquin Local Health District. (Signed)----------------------- •- ----� ----------- -------------------------------------------------------------------- -------------------------------------------(Owner and/or Contractor) By%_---------------- ----------------- -----•-------------------------------------------- --------------------------------------(Tifle)---------------------------------- --- (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 APPLICATION ACCEPTED BY------- ------- -- ---------- ---------------••----------------------- DATE----------:F C`--{---------- ------------ REVIEWEDBY-------------------------------- --- ------ ----------------------------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------- --------= Alterations and/or recommendafions----------------------------------------------------------------------------------------- ------------------------------•-----------•-----------..------------- ----------------------------------------------------------------------- -- ----------- ------------------------------------/------------------------------------- ------------------------------------- - --- ----- -------------------- --- r FINAL INSPECTION BYDate_ --� -� -- .- -------- SAN -JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street q Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Revised 6-'59 F.P.Ca.