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APPLICATION FOR SANITATION PERMIT Permit No. .............�7�._�, n Lk �� 1 (Complete in Duplicate) 3 V( 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 applicationis made in compliance with CountV Ordinance No. 49. JOB ADDRESS AND, LOCATION' ---- -� 4,4 ehti.�.. --- ---- Owner's Name ---•--- - ----01�— -------- ------ Phone r Address 7 - Contractor's Name____ _________ ________ __?" e ! ,,00� ---------------- --•--- Phone -.4e.Z7._r*---- -- Installation will serve: Residence ❑/ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units, __e_ Number of bedrooms � . "Z7 Number of baths__f___.__ Lot size .___. !J •_...... Water Supply: Public system 2--community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ElClay❑ Adobe2y_*"Hardpan ( , Previous Application Made: Yes<❑ No 91-'<ew Construction: Yes [B''Tlo•❑ FHA/VA:Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T c Distance from nearest well Distance from f undation __.Material No. of compartments____- Size .______Liquid depth_.- __------------- Disposal --- ----Disposal Field: Distance from nearest well,,; — ___Dis encu om foundation.__ :d..__. Distance to nearest lot lm®..... ......... i ED Number of lines__ Length of each line-.,'� __ __- _ __.Width of trench Z`le'o Type of filter material __Depth of filter material•_ /-.•,____.__Total length-__:___ �C'�: __'_______ ________ 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----------------------------------- ___-___-_ _Distance from nearest building ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):_--_-___ _-._____ x. - ------- ------- ------ -------- ------•- ------•-------------- ------ ------- I hereby certify that 1-have prepared' iq that the work will be done in accordance with San Joaquin County rices, State laws, sand recd �PVnd , Joaquin Local Health District. ordina eptic '!an v��3 (Signed)_ 1206 So. Eidc o F0 2-7046 t Stozlci6W, C�iif -----------------------__ ___( ner /or Contractor) BY --•--•. ...........................................-------------------------------------------------------------- Title _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- bATE REVIEWED BY---------_------------------- 5 t ------ --- DATE-- BUILDING PERMIT ISSUED__-__ _____- -------- ____,___. DATE--_- -•-- -_� ......................... Alter tions and/or recommendatjo ----------_------- ,_- ____.__-- ,..__ ........ . --- ` G,-- Ott a .— ------------ -- •.... -------. _.._•••. ••. ._.. •--••-•-•--•---- r , FINAL INSPECTION BY:. 1t_: Date------- , M SA JOAQUIN LOCAL HEALTH DISTRICT:.. 130 South American Street 300 West Oak Street 132 Sycamore StreetL 814 North "C" Street Stockton, California Lodi, California Manteca, California -yraey, California ES-9-2M . Revisea 1.57 F.P.CO. yj 1/1 t.�