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APPLICATION FOR SANITATION PERMIT Permit No. 1� (Complete in Duplicate) Eb/ Date Issued ..... ---4...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 O inance No. 549. JOB ADDRESS AND LO A ON---- - Xf =.. Owner's Name.... 1� --------�--- --------- �, --------------- Phone ...._.-_... )I Address---------------------- -----------�k�!�.-.- ------ ------ ---•---+ex---- ---t----- Contractor's Name----------------- 'ti!r' -------------------------------------------------------------------s -------• •••--- Phone ...•..... ..... ----•- Installation will serve: Residence P--<partment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other Cj Number of living units: ---�.__ Number of bedrooms _3 Number of baths _1-__- Lot size ./.�`_.A...LO 0 Water Supply: Public system ❑ Community system ❑ Private [9-15epth to ater Table .'�___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ H'ardpen 0. Previous Application Made: Yes ❑ No ["'New Construction: Yes R�rlNo ❑ FHA/VA: Yes ❑ No P--00' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or`cesspool permitted if public sewer is available within 200 feet)� Septic Tank: Distance from nearest well_-SO W?eista ce fom u otion _C2--_. --..Mat nal----. d� . f�-------- ® No. of compartments_ ;--- -----------------$ize_ _____ ______Liqutd depth___ Capacity... Disposal Field: Distance from nearest well 6a 'ft'`_"Llstance from foundation/Z 'T�t^-,Distance to nearest lot line Number of lines......3..........__. Length of each fine__ `�' •y o��o Width of trench '�+`+� .. Type of filter material____- h_ Depth of filter material...1.>t ------------Total length-.___._t-- .................. 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------------------------------------------ El ___ -.---:--_ -- _.-__-_---__---❑ Distance to nearest lot line----- ----------- - ----- -- -----------•------- •-------- =-•- ---.................---------------------------- Remodeling --- --Remodeling and repairing (describe :--- •. ------•--•- ......••• ......--•---••--- •..... ........ . I hereby certify that 1 have prepared this ap ication and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and es and regulatio f the Un Joaquin Local Health District. (Signed) ----- � ---- --------------------------- ---------- ------(Owner and/or Contractor) By:--------------------------------------------------- --------------------------------------------------- -----------------------(Title)....................................- - ------ - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). O RT T USE O LY APPLICATION ACCEPTED BY -.�'°�' ''z-.- -= ---- DATE-/ ...................... REVIEWED BY----------------------- ----------------------•------•------------------------------------------------------------------------ DATE...................-....................................... BUILDINGPERMIT ISSUED...........--------------------------------------------------._......---- ••.,..--- .•-•-- DATE----------•--•-•--••... --........------.................. Alterations and/or recommendations---------- --------- .......................................................................... .---:... .._._.., ......... J -..... ..... ' ...........1_ t. $" � `. s `... .._ C.. ...........%�+-... .... ---•�' � �--�=�. � _...... -.... ------------------- FINAL INSPECTION BY:. ?4146 --------- •---------------- Date----- t `� ----------------------- 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 F.P.CO.