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7 jLV1, APPLICATION FOR SANITATION PERMIT Permit No. ._.,l-.f 3/11 (Complete in Duplicate) / Date Issued ___1_ 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 No. 549. a JOB ADDRESS AND LOCATION----• - i�- ` �------- . /j� --------------------------------------------------- - Owner's Name... _.YeYe_.L-. .-_... Phone. 3 .X ---- Addr'ess - - - -r Cl---- --- --------------------------------------- .. pp Contractor's Name --------- -- --- - --------------------------•- ------ Phone,. Installation will serve: Residence 21"X'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ of bedrooms Z. Number of baths .1____ Lot size ____��_X_�a.� . _ ---- ------------------ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gg-`gardpan ❑ Previous Application Made: Yes ❑ No 2r New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if�jublic sewer is available within 200 feet.) i Septic Tank:� Distance from nearest well_ _Distance from foundation---AP-------.Material_ No. of compartments-------./_P-------------Size.__-__��_��...__.---Liquid depth--------14 ----._:.__.__Capacity___ -- Disposal Field: Distance from nearest ell4_X " Distance from foundation../. ------------Distance to nearest lot line.____.__ +� Number of lines ------- Length of each line-------------yam__.......Width of trench_____ Type of filter material-_�__e__.__ _Depth of filter material-/9-i ------.Total length-------- !- --------- Seepage Pit: Distance to nearest well______________ _______Distance from foundation----................Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material-------------.---------Size: Diameter____-_--_---.-__-___'Depth--____-----_-__-_____________- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--_-__---_----_--_--__-__-__-_______. ElSize: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________--___--__--._-_____.---_--_--_-_. ❑ Distance to nearest lot line-------------------------- ------------------------ Remodeling ----------------------Remodeling and/or repairing (describe):_ _ . _, ------ ------- ----------- ----- - - --�' . -----=------------------------------------------•----------------•-------------------------=---------------------------------------•------------------------- ----------------------------•------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------N--- I hereby y that I h v repared this application and that the work will be done in accordance with San Joaquin County ordinances, S 1 w le and mg tions of San Joaquin Local Health District. (Signed)_______ _ ___ _____ _ _-__(Owner and/or Contractor) By: `— -------------(Title) ----- (Plot plan, showing size of lot, I'cation of system in relation ells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------- ----- ---------------------------------------- DATE----/.-------- ------ REVIEWED BY-------------------------------------------------- ---- - --- DATE--- --7 BUILDING PERMIT ISSUED-------------------------------- ------- ---------------------------- DATE-----------------------_--------------------_... Alterations and/or recommendations------------------r---------- ------------------_-- ---------------------------------••------------------------------------------------------------ -------------------------------------.----------------•------------------------------------------------------------------------------------------ ------------------------------------------------------------------------- - ---------------------------------------- FINAL INSPECTION BY:______ ate f -------------------------------- 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 , Revisea 1.57 F.P.CO.