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APPLICATION FOR SANITATION PERMIT Permit No. _ &43��j_.. (Complete in Duplicate) / r 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. C stJOB ADDRESS AND LOTION----- ---/----f----- --------- ------------------------------------------------•--.-.-------------•--------------------------- Owner's Name--- 0`--�.---- --A-DA47---------------------------------- ------------------------------------ -------------- ---- ----- ------ Phone-----•---- - Address---------------=!-'a:1n.�------------------- c Contractor's Name /Y !a -! y^---- --- -- Phone K�n Installation will serve: Residence [K fipartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms -22.- Number of baths ----I--- Lot size ------------------------------------ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table _�Ij`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4 Hardpan ❑ Previous Application Made:. Yes ❑ No W 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--____--__----.__..-_-----_-..--.--.--.___-_._-. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation-------.------------Distance to nearest lot line----------------- 0 Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of fi er material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well__' -------Distaofroundafion---1__a.`____.._.Distance to nearest lotNumber of pits.-----j--------------Lining materi ------Size: Diameter-----X?-----------Depth.----- r5`' ------------- Cesspool: Distance from nearest well-----------------Distaundation.__._ .---_-.----.-.Lining material-----__-- - _----------..._____-_F] Size: Diameter------------------ -------- -----------Dept ----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_----------------------------------------------Distance from nearest building-_------_____._______________.__..____._. ❑ Distance to nearest lot line---------------r----------------------------------------------------••- ---------------------------------------------•--------------------- - Remodeling' and/or repairing (describe):----------------------------------------------------------------------------------------------- --=----------------------------------------------------- ----------------------------------------------------------•---------------------------•------------------------------------------I---------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate'laws and rules and regulations of the San Joaquin Local Health District. 1-ke's Se t-ic Tank Service (Signed)------------------------------• -------------------------------------- - --- -- - -------------- -- - - (Owner and/or Contractor) ------ ---------- -------- ------------------ By:---•----------------R�!JTF-4r_B0X__62fi--------- = (Title)------- 1r (Plot plan, showing size of lot, location of system in relation to v Is, buiidin9s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. } -------------------- -------------------------------•----------- DATE-_.---- rt J REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:----__-.-____ - - - - - - - - -- - - ----- -------�?lAl � -------- ---------------------------------------------------------------•------- ------ -----------------_------------------------------------------------ ---=--------------- MIT--- # ...... ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- -- ----- •-------------- --- -------------------- - ------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--_ - Date------- 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-9-2M . Revisea ;-57 F.P.CO.