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� APPLICATION FOR SANITATION PERMIT Permit No. kv��1 (Complete in Duplicate) Date Issued �rzl 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 compliancp wit Count}t Qis�n�9• JOB ADDRESS AND LOCATION_ ' 0. J --- ---------------- ---------- Owner's Name-70 -----s $ --------------------------------------------------------- --- ---------------- Phone------------------------------------ Address------ Contractor's Name -- I �� I,lehj--------------------------------------- ----------------------- Phone ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms __ __. Number of baths ___1____ Lot size ----------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table .204__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ❑ : New Construction: Yes 5fl No ❑ FHA/VA: Yes ❑ No f 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___ (.•____Distance from foundation-----LA________Material__.. �, --/'dlG - -------------------- [ No. of compartments-----_ ,---------------Size__r�$_!!_��SJ_____--:---Liquid depth-----P,(_ ---------------Capacifyjz;' _-_----_-- - r 4 Disposal Field: Distance from nearest well....,�6 ._.Distance from foundation---14-__________Distance to nearest lot ® Number of lines------------2 ------Length of each line----------75: -----.------Width of trench---l_-y-��----------------- Type of filter material_-_ kd{__________Depth of filter mater:al__-_/$_...........Total length-------A f?------------------------ Se gg "fi Distance to nearest well----3-6------------Distance from foundation----A ---------Distance to nearest lot iine__-1------------- [A -_ _______-® Number of pits--------Aa----------Lining material---- 7?'4€_�------Size: Diameter---kX(X----------Depth-----✓7"---------------------- 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------------------------------------------ 11 ___--_________-________❑ Distance to nearest lot line------------------------------------------------------- Remodeling and/or repairing ( escrib }:--__ --------_- ----------- ' ------`T04.� - - -- - - --- � ---- "- - -- _-------- ------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- - -----------------------------------------------------•---------- ----------------- --------------------------------------------------- ------------------------------------------------------------------------------------- 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. (Signed)-------------------------------------------- --------`---�4*/------------ U __(Owner and/or ontrac or t By:-----------------------------------------------------------------------------------------------------------------------------------(Title)-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY------------------------------ -------------- DATE------------- - BY---------------------------------------------- -- -- DATE I) -IT .1 ------------------ ---------------- UILDING PERMIT ISSUED - DATE----------------------------------------- Alterations and/or recommendations________________.________.. E ------------- ° =-------------- ----------------- -------------------------------------------------------------- -------------------------------- --------------------------------------- -------------------------------- -------- --------------------- FINAL INSPECTION BY:.-___________ r =C ----------- ----- Date -�9 SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revised 1.57 F.P,CO.