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APPLICATION FOR SANITATION PERMIT Permit No. JL7.0.L (Complete in Duplicate) V- vDate Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr t cl�'nsfall the work h3prein_descrjbe4d ,,, JO ) This'application is made in compliant p,with County 0r r U finance 49. ----' - Wk-B ADDRESS L CATION - - ---- ---- - - --- --- ----- ----- Owner's ---------- -- ------------- - ----------------------- --------------------------------- - -------- Phone Address--------1 ...... ------- ----- Contractor's Name - ----------------------------------------------------------------------- Phone----------------------------------- --------- lnstallafioiWill-serve: Residence N, Apartment House E] Commercial E] Trailer Court ElMjel Other P er Number of living units: ---V--- Number of bedrooms —3-- Number of baths -----1- Lot size ---- --- - —------------------------ Wafer Supply; Public system [] Community system E] Private [&_ Depth to Water Table F ff:-, L Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam 0 Clay E] Adobe E] Hardpan E] Previous Application Made: Yes [] No [a� New Construction: Yes K..[No El PHA/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---§-Q-----Distan_3 from&-ur-'4atiofl-------!L-0-------t�,latriai- Size---- ---Liquid depth____---- acity---- K. No. of compartments----------2----------V 4Z---------------cap ,4; Disposal Field: Distance from near�sf well___. ----Distance from foundation- Q_.____-Distance to nearestoflinle----v-------- Number of line ------------ Length of each -----Width of trench__ ._ ------------------ Type of filter material---.-Z-'--- -Lepfh of filter material--------- --------Total length-------�-Klo-------I------------------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation---.,,-.,-----------Distance to nearest lot lin I e______________._ El Number of pits----------------------Lining material-+_--- _-_. -'�-.-Size: Diameter------------------------Dept h------ ------I------------------ Cesspool: Distance from nearest well_________________Distance from foundation._..________.______ Lining material______-----------_ ------------------- EJ Size: Diameter--------' -------------Depth----------------------------------f----------------Liquid Capacity---------------- ------------------ ------------gals. Privy: Distance from nearest well-------------------------------- --..............Distance from nearest building___________-_--_______--__________.____._- 1 ❑ Distance uiHing------------------------------------------ Distance to nearest lot line------ ---------------------------------------------------------------- - -i I ------------------------------------------------ Remodeling and/or repairing (describe):------------------------------------------------------------------------ ------------------------ ------------ ------------------ ---- ------- --------------—11------------------------------------------------------------------------ -------------------------------------------------------- 7 ----:----------------------------------------*-------------I------------------- -------------------------------------------------------------------- --------------------------------------------------------------------d---------------------------------I------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•----------------- =---r--------------------------------------------I------------------ 1 hereby certify that I have prepared this application and,'fhat'fhe work will be done in accordance with San Joaquin County ordinances, State Ila s._and, rules and regulations of the San Joaquin Local Health District. -- (Signed)� ----------------------- ------------------------- ------------------------------------------------------------------ ---------------(dwner and/or 'Contractor) By:------------------------------------------------------------------------------------------------------I------------------------------(Title)------------------------------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 166 placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ---- --- ------------ ---------------------------------------------------------- DATE------- - -------------- REVIEWED - REVIEWED BY------------------------------------------- - ---- --------------------------------------- ----------- DATE---- --- -------------------------- BUILDING PERMIT ISSUED--------------------------- ----------------------------------------------------------------------- DATE Alterations and/or recommendations:________.___._. ---------------------------------------------------------------------- ----- - ------ - ---------V - --------------1------------------------------------I------------- - ------ - - ---------- -------------------='------ -------------------------------------------------- ----------- - ----------------- ---------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------- --------------------------------- ------------------------------------------------------------------------- --------- -----------I--------------------------------------------------------- ----------------------------------------------- ------ FINAL INSPECTION BY:--------116vi, f ---------------------------------------------------- D,t-------- ---------------- --- ------------------------------------ SAN JOAQUIN LOCAL,kE ALTW-DISTRICT 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 Reviseci 1.57 F.P CO.