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APPLICATION FOR SANITATION PERMIT Permit No. ..444 _f___ 1 (Complete in Duplicate) Date Issued ____/1kq__ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. x.t.This appiication.is made in compliance with County Ordinance No. 549, v5'3—t ^� JOB ADDRESS AND LOCATION_-- f` l•sl�x,dw—.4 _44e l..__. �f--�. .Owner's Name--- ----------- k --------- f ------------------------------------------------------ Phone------------------------------------ Address r�-�.- 49 Er.3{ sus-"----- `� Contractor's Name---V4f?-±&---------------------------------------------------------------------------------------•--•----------- ----------------- Phone----------------------------------- Installation-will serve: Residence fiM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _11 ___ Number of bedrooms ----- Number of baths -------- Lot size __ -- �gnr�,,�,y__ _-�r7•-! (Q} Water Supply: Public system ❑ Community system,❑ PHvvafe ® Depth to Water Table 0_-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyL am❑ Clay Loam N Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No TR New Construction. Yes)C No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-_-A—*___Distance from foundation_-.A9----------Material__ Gv ^----------------- -- 91 No. of compartments-------k--------........Size__ _!' "_4-___'"---Liquid depth------It----------------Capacity__PP----------- Disposal Field: Distance from nearest well---fo--------Distance from foundation-----)_�7---------- Distance to nearest lot line_I-°a._------ Number of lines----------1----- �-:"__p""---_Dep hN,of each line----=07 .Width of trench----7`'j TType e of filter material'„ tc of filter material-----f_$"-..........Total length------ -------------------------- See a e Pit: Distance to nearest well------------- -_Distance_fromtfoundation_;_..� ._._ rh~ p g Distance to nearest lot line---- Seepage ❑ Number of pits----------------------Lining material—I_-__-___._______-.Size: Diameter------------------___-_.Depth_.---------....________...._. Cesspool: Distance from nearest well________________Distance from foundation-___`-__r-_' Lining material-_----_--__________----._----_-_----. ❑ Size: Diameter----------------------- -------------Depth----------------•-----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line Remodeling and/or repairing fdescribe):---------------------- ----------------------------------- -------------------------- --------------------------------- - -------------------------------------------------------------•-----•-------------------------------------------------------------------------•--•---------------------------------------------------------------------------- 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. (Signe / ------------------------------------------•------------------------------------------------(Owner and/or Contractor) �It By:-----------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 11, FOR DEPARTMENT USE ONLY ------------------------------------------------------- APPLICATION ACCEPTED BY-_-- --_-, -_Z1 _______________ DATE_ _'/,�--' -_.--_-_ -�u :-------------------- ------ ----------------- ----------------------- REVIEWEDBY----------------------------------- ---------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------•-------------------------------- ------ DATE ---------------- Alterations and/or recommendations:----------------------------------------------- ----- --------------------------------•- -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------•--------------------------------------------------- I ---------------------------------•---------------------•------------------------ •---------------------------------------------------- ------------------------------- ---- i i ,1 FINAL INSPECTION BY-004 ------------------------- Date- 6. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.P.CO.