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�v APPLICATION FOR SANITATION PERMIT Permit No. .... i C ( omplete n Duplicate) ff Date Issued .`�l1�/'�'_.e___ This Permit Expires 1 Year From 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 application is made in compliance with County Ordinance No. 549. 1 � 33� JOBADDRESS AND LOCATION------------ --97-------------------- ------------------ ---•-------------------------- ------ Owner's Name------ - ' ' =--- - ' ' '--------------------------------------------------------- ------- ------= -;- . Phone--------------------•--------------- � _ ' Address----•------ •. ......=-- ----- > ' Contractors Name--------- - *---- -------- I------------ ------------------------- Phone. .06.. Installation will serve: Residence Apartment House ❑ Commercial ❑ 1 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --.1--- Number of bedrooms __ Number of baths ----- Lot size " tk___ -.-113S#----------------->__-----____ Water Supply:' Public system ❑ Community system N Private ❑ Depth'to Water Table AS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑ Adobe it Hardpan ❑ Previous Application Made: Yes ❑ No (t' New Construction: Ye ❑ �No ❑ FHA/VA: Yes [ ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ( P P P P { Septic Tank: Distance from nearest well ---. -Distance from foundation -____.Material-04-8-----i Kt No septic tank or cesspool permitted if public sewer is available within,200feet.) ' No. of compartments---- -----------------Size--__- � -- .- _____Liquid depth- _--.--------------Capacity __,_ -------- Disposal Field: Distance from nearest well _._.Distance from foundation _--._.Distance to nearest lot line_-_ �--------- , Number: .of.lines_ '_ ti�_ _Length of,each.line -,.: *---------------Width of trench ------------------------ Type of filter material-__ J**—*---"- *Depth of filter material--------,�" __---_Total length_- Seepage Pit: Distance to nearest well _-_ _._-Distance from foundation .' ...Disnce to nearest lot line El Number of pits__. _ ____ . Lining material-_--� ' _____Size. Diameter -1-11.-._ ___.___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----------------------------------------------------------------------- -------------•-------------------------------------------------------- tAv Remodeling and/or repairing (describe)---------------------- --- -- - "- -' ---------------------- ---...----------------------------------------------------------------- ---------•--------•------=-----•----------•--------------- ----------------------- -----------•-------------------------------------------------------•---------•----------------------------------•---------------------------------i------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------•-- ------------------------------- I hereby certify that ['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. 'I (Signed).------ ----- Aft _ -------- --- (Owner and/or Contractor) By:-------------------------------------- ------- -- -------�elatriion 4 - -------- ----- -----(Title) fd " (Plot plan, showing size of lot, location of system ' wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------•----- -- ------ 11;-7:------------------------------------------ DATE---------- 45--f---------------------- REVIEWEDBY------ ---------------------------------------------------------------=-------------------------------------------------.. DATE-----------=----------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------=----------- --------------------- Alterationsand/or recommendations----------------------------------------------- ---------------------------------------------------------------------------------------------------------------- -------- --- ---------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Date ------------ FINAL INSPECTION BY-f __-•- -------- --------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M Revised V59 F.P.Co.