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r �b APPLICATION FOR SANITATION PERMIT Permit AeW0 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin L al Health District for a permit to construct and install the work herein described. This application is made in compliance with Cou Ordinance 549. JOB ADDRESS AND LOCATION-- �- 4?p 1 ----- -------------------................ ••-••••- ------- - Owner's Name... --- .LkAA.1------�I.J1 �-a-k..&---------•--------•-------------------- ---- -------• ----- --------- Pone_ _. ]_ Address �Y rn� - ----------- Contractor's Name- f --- �y-----•+-- ---! � ------_-------- _---_- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail r Court ❑ Motel ❑ Other ❑ Number of living units: ..t---- Number of bedrooms __umber of baths.%___._ Lot size __.. .................................... Water Supply: Public system [ICommunity system E] Private,2�_ �,Depth to Water Table � ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes*No ❑ New Construction: Yes ❑ No)4_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) tic Distance from nearest well-________________Distance from foundation--------------------Material................................................. No. of compartments--------------------------Size--------------•-----------------Liquid depth--------------------- --Capacity ---- ispos ie d: Distance from nearest we 49--__ .__Distance from foundation-------0-'.....Distance to nearest lot line-,X-1...... Number of lines. __ ----------Length of each line_. 9,0" Width of trench f>�------------._. Type of filter material____ _ -_( f_ Depth of filter material___/��___.__Total length..._... ._..... .................. - r-------- Seepage Pit: Distance to nearest weli_/Q4_-----------Distance from foundation�o---------Distance to nearest lot line.__ _:- Number of pits--I------------------Lining material_!`_c Size: iameter ,,3 ---------Depth._-0-S ................... 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 ,,, --------- ------ ------ -------- ...............------ - ----- -- �. Remodeling and/or repairing (describe):-- -----------------------•------------------------------------------•--------..................................................... ----------------------------------- ------------ ----------------------------------------------------------- ---------•---•----•--------------------------...-- •----••-•---•--•--••. ....----•...._-----•----,...--- I hereb certify that I I v ) MAL"s application and that the work will be done in accordance with San Joaquin County ordinance laws, and 11 �1f� ions of the San Joaquin Local Health District. Septic Tianlr Ss -s- HO 2-704 DAYS �r Contractor) (Signed)--- -- ----- -- - - ---- Stockton, Calif ( f�--------------------------------------------- gY: -------------------------------------------------------------------------- ----- -- �`"`� l -- (Title) (Plot plan, showing size of lot, location of system in relation t ells, building, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_--------------------- ----- ------------ ------------------- -•---------------• DATE---.---- REVIEWEDBY----------------------------------- --------------------- -------------------------------------------------- DATE--- --- it ' •-- BUILDINGPERMIT ISSUED--------------- -------•-------------- ........ ------------- -------------------- DATE.............. .......---- ---- •-•••---•- Alterations and/or r ommendations---------= ........... --------------------------------------------•--------------------------•-----------------._..........--• •----------------------. ---- -- . . ... ------------------ -------------------------------------- .......................................... za_ --•---. .__... -•-. --- ..... .. .... .... FINAL INSPECTION BY:----------- /V---v----- - Date. L k SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Strut Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.