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APPLICATION FOR SANITATION PERMIT Permii No. (Complete in Duplicate) Date Jssued --- ----- Permit — Permit Expires 1 Year From Date Issued Irk C!- b ication is hereby made to the San Joaquin Local Health District for a permit to construct and install +hew erein describe �g This application is made in compliance with County Ordinance,No. 549. RjJOB ADDRESS AND,LOCATIO '_a- a:.Y----- " ---------- ' Phore�.'- Owner-s Name-'--.- - ---- ------------- Address-------- ..l .. j- r Contractor's Name__. � � 3 't-� -----•-- Phone.__ .: .S�®S Installation will serve: Residence Apartment House ❑ Commercial ❑ TrIz' Court ❑ Motel 01 Other ❑ Number of living units: J____ Number of bedrooms _ -_ Numb er of baths ___I___ Lot size --------- ---•------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table __- -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ AdI obe [3Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r " [ Septic Tank: Distance from nearest well _: _ L?___.___Distance from foundation_______ _____-------MaterfaL-_-.--- ----- _ ___._ ___- No. of compartments ----Size_1S___--.j----------Liquid depth-----�------- ------- apacity.a/'.�a-r - I. (N �_t:.______-.Distance to nearest lot line_____--..- Disposal Field: Distance from nearest well-___.Z_-0--___Distance from foundation_-.- ., r Number of lines-------------------------------Length of each line----------4,0_ - -----Width of tree�h------- - ----f------- ------- Type of filter material___._/66,jj�-----Depth of filter material------/,f ------Total length________ ------------ �J Seepage Pit: Distance to nearest well _________------------Distance from foundation------- Distance to nearest lot line---------------- El Number of pits----------------------Lining material------------- ---------Size: Diameter-----------------------.DePtn------ ------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation-,----------------kLining material--------------------------------------- �rt L1 Size: Diameter------------------------------------- Depth------------=------- ---------`-----------------._Liquid Capacit(y-- -•-----------------------gals. :1I l Privy: Distance from nearest well______---------------------------------------Distance from nearest building__.I-.-__---_._______________- _. ❑ -- --------- , Distance to nearest lot line - --------�----------------------------------------- --: --------- • - _. Rerriod ------------------------ -eting and/or repairing (descri4 e):- -----------------------------------------------------------------------------------------------•--- --------•--------------------------------------- �I ----- ----------------------------------------------- 5 ------------------- ------------------------------------------ -.:r------------------------ ----- -= 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.] w - Si ned - "` .2 s y ( / Contractor) ( 9 )- ----•- ----------------- - ff i of (Title) �I. Y:- ------ --- ---- ------ ------------- ---- (Plot plan, showing size of lot, location of system in rela n to wells, buildings, etc., can be placed on neve'a side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- - s----------------- DATE_ `L REVIEWEDBY------------------------------------------------------------------ --------------------------------------- DATE_ = BUILDINGPERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE--------------------' ------------------------------------- Alterations and/or recommendations:-------- ----- »^ - 4 ----------------------- - - ----------- -- ------------------------------------ ------------- --------------------------------------------------------------- -------------I�------------------• ---------------•- { t ----------------------------- f`------------------------------ ------------------ -------------------- ---------------------------------------------------------- . . 4 ---------------------------------------- ------------------------------------ ---------------------------------------- FINAL INSPECTION BY. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street F Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.