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I UAy35- APPLICATION FOR SANITATION PERMIT Permit No. _� _ -�U__ (Complete in"Duplicate) Date Issued ----------- ---------- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. Jill 90B ADDRESS AND LO 710N -- �--- ' ---- ----- � -�',: -- rEr4`:� - ------------- - V. -V ��- --- ------ 4 wner's Name----------------- TAA__ = _'-(--'``------------------------------------------- ---- Phone � _. __ X:I� ddress-------------------------------------- Ct�lV1� [--------------------------------------------------------------------------------------------------......--------------------------------- 0i; Contractor's ailName__: Phones-------------=--------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1------ Number of bedrooms _3--_ Number of baths _ _. Lot size --_ ly---------------------------- �.: Water Supply: Public system ElCommunity system ElPrivate ® Depth to Water Table .__.____ ft. 1 haracter of soil to a depth of 3 feet: Sand ElGravel ElSandy Loam 2, Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan El III; illrevious Application Made: Yes ❑ No ❑ "New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ .� 1 TYPE OF INSTALLATION AND SPECIFICATIONS: IIy (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) T N II Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --_-___.__---_----_------_-__--_-_-_____--_-. l❑,"�"` No. of compartments---------------------___Size_._---•------------------------Liquid depth-------------- - --------Capacity-----------------------.4 - e i/ Disposal Field: Distance from nearest well_�_P__'I__D�stance from foundation___-_4__---------Distance to nearest lot Number of lines-_-_`? "�_____._-_______-__Length of each line________- r Width of trench...3_ * fi': 4 Imo' g �f �� Type of filter material_�c�"'��_h-----------Depth of filter material-____.--------------Total length___.--- � ``.- (� Seepage Pit: Distance to nearest well ----------------- ---Distance from foundation__-----------------Distance to nearest lot line--.-------.---_._ ' ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------- -------Depth---------._.-----_--------------- esspool: Distance from nearest well____-----_.''--Distance from foundai-ion-------------- -----Lining material-______-___-- ill ❑ Size: Diameter------------------ -------- - ---- -Depth---------------------------------------------------Liquid Capacity----------------------------gals+ Privy- Distance from nearest well---------------_---------------------------------Distance from nearest building-----_._-_______-_____-___-____----I. ❑ Distance to nearest lot [ire--------------'-�-- -- -- ----------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------t .�--,_----------------A;! ---------- l ------------------------------- ------�4-------- ------------------------------------------------------------------------- • � _ _ -- - --- ------ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County iordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Sined 7�J _ - 'f =�- ----------------------------------------- 9 )--------•-�•'�=-'--------- ------------------------------------------------ --------(Owner and/or Contractor) B i-1-•---•-- ---•-------------------- -------------------------------------------------------------------------------- -- Title--------------------------------------- ..---------------- - ---------------------------------------------- - -(Plo+ plan, showing size of-lo+, location-of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i6PLICATION ACCEPTED ----------------------- -------------------------------- -------- DATE-----i�------ ------------------------------ REVIEWED BY-------- -------------------------------- - --------------------------------------------------------------------- --------- DATE------ ----------------------------------------------------- - BUILDING PERMIT lISSUED--------------- -- - ------------- --------- DATE -------------------- I - �- --- - � ____ AilAlterations and/or recommendations --------------- ------ --------- ------ -- ;tl - --- -- - ------ -- - -- --------- -------- ------- --- --- I ------� ------ ------------------------------------ 'I �, / v - - I FINAL ..INSPECTION BY:- / -------------------- Date-- --��. ----------------------------------------- SAN - ---------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT ij 130 South American Street 300 West,Oak Street 132 Sycamore Street 814 North "C" Street i i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.P.CO. I .