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0 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �./ Date Issued __._._ Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the r e in desc ibe This application is made in compliance with C my Ordinance No. 549. Awn JOB ADDRESS AND LO ATION /'-- --------- A_EI�` ` -ti Owner's Name----------------1 . -•--- - ---------------------------- - Phone------------------------------------ Address----------- Contractor's Name -------------------------------------------------- Phone---------------------------- Installation will serve: Residence geApartment House ❑ -V;Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: -__!__ Number of bedrooms . __"Number of baths _A20 Lot size-__A&A&— !!�--------------------------- Water Supply: Public system Community system ❑ Private:,❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ S4 Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No &'*** New Construction: Yes PrNo ❑ FHA/VA: Yes @R'O'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 wel _/A*t/-bistance fr m foundation-----44........MatQria_l.... _------. [� No, of compartments------�- --_--_Size----5fA_e_+VA0.Liquid depth_ ___ _--_______ Capacity...AP, r,�' Disposal Field: Distance from nearest w II__'",&W distance from foundatiop..—/0. to nearest lot line...#,Q_._.. Number of lines___.-____ _____ Length of each line_ -- - -----Ab-Width of trench-----�"'� ________________ Type of filter material_!t_�� Depth of filter material ._.It-e!-----Total length.-----rZ►Q,0-------------------------� Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__-.--_____-_____ p Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Dept h-________-_______________-_______ 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------------------------------------------ F1 Distance to nearest lot line-------------------------------------- ---------- ...............I-------- --- -•--------•---------------------- Remodeling and/or repairing (describe) ��G!if--- �'`. �'� • --------------------------•--------.1--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------•----------•--------------------------------------------•------------------•--•------------------ --------------------- ------------------- -- --- -- 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. 02- ----------- (Signed) Contractor ---------- ( OWIRM, By:----------------------------------------- ----------- - - ----------------------------(Title)---� ---------------- (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYJ DATE27— = REVIEWED BY DATE...1,P -•--•-•------•-••--------•---•------•-•-- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------%--_------------------------------------------------ DtN Alterations and/or recommendations__________________________________ --------------------------------------------------------------------------------------------------------------------------------------------............................................................................... --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------•---------------------------------------------------------------------------------------------------------•---------------------------------------------------------- ----------- ------------------------- ------ --------------- FINAL INSPECTION BY:.. . --------------------------------------- Date-----Lu--- ------ --a—&------------ 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 : Revised 1.57 FY.CO.