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/ APPLICATION FOR SANITATION PERMIT Permit No. .6 .� (Complete in Duplicate) Date issued K . 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 N . 549. '�.. JOBADDRESS AND L ATION r'�L v -----r--------- - '----------------------------------------------------------------------------------------------- Owner's Name-------- --- ------------------------------------------------ - ----------------------------------------- Phone------------------------------------ AddressI--'�► J-------------------------------------------------------------------------•--------------------------------------- Contractor's Name----------- -------------------------------- -----------------------------I---------------- Phone----------------------------------- Installation will serve: Residence gr_A�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t , Number of living units: __/--- Number of bedrooms __ _ Number of baths _Z--- Lot size ► _ _l2 ---------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table left. Character of soil to a depth of 3 feet: Sand [-] Gra l E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No g?' New Construction: Yes [��No ❑ FHA/VA: Yes ❑ No [J— TYPE rTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--'—_ q ._ �Distancee�ffr2p foundation----��_f____.Matersal--------------� ____. 7y No. of compartments ------------Size--- Liquid depth____' L �..________Capacity_____ U Disposal Field: Distance from nearest well .____ =__Distance-from-foundationp_�`�49_�__-Distance to nearest lot line____'_-�_ Number of lines________1_____1_____--_..t Length of each line_____---%P_---s�-----Width of trench______ ___ Type of filter mate ria 1-/ Depth of filter material-----zoP_________Total length__________%a______________� ___ i Seepage Pit: Distance to nearest well -�-__CDistance f m f ndation___-_-1G_-___.Dista`p to nearest lot line__.__.________ Number of pits----- -------------Lining material_____ _u i,' ------------ --- - p ---Size: Diameter__ _ ---- Depth 0. Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material-------------------- ❑ Size: Diameter------------------------- !` --__-Depth----------------------------------------------------Liquid Capacity------------------ -- - gals. Privy: Distance from nearest well-_____ -----------------------------------------Distance from nearest building--------------_-->-._______________-__- ❑ Distance to nearest lot line.--- 4 , Remodeling and/or repairing (describe)_-------------___,(_W - i ---------------------------•---------------------------------- ---------------------------------------------•-------------------•------------------------------------------------------------------------------------------- ----------------- t-----------•-------- ------------------------------------------------:------------------------------------------------------------------- ----------------------------------- - -------------------------------------------------------------------------------------------------------------------------- -----------•-------------•-•----------------- -------------- ; 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}---------------------- - _ - _ -(�Contractor) - ------ -- ----------- ----- --- ----------------------------- - bY� - ------------ (Title) '� (Plot plan, showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------ ----------------------------------------------------- DATE-------------------------- ---- -------------------- REVIEWEDBY----------------------------------------------------------- - ------- ------------------------------------------------------ DATE-------- -------- -- --- ------------•------- BUILDINGPERMIT ISSUED-_------------------------- - - - - ------ ------------------------------- ------------------ DATE---------- ----------------------------------- Aiterations and/or recommendatio -- - - --- ------------------------------------------------------------ -•------------ ------------------------------------------------ -------- ----------------------------------------------- T------DfF P T.H---------95--�------ -- -- -------- -- -----------7171 0-------------------------------------- FINAL INSPEC BY:. - -------------------- --- --- Date /7__97.5 .----------------------------------------------- SAJOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 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.