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VA, �- ��/-1' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 0��;nrlication 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. JOB ADDRESS AND L CATION.-- ---cJ-p�/----------® Owner's Name-__e_54---- --------•------------------------------------------- - ------------------------------------ Phone----------------------------------- Address---------- •------------Address---------- "r---` 2,e---- ---- --L- ---------- -••--------------------------- -- ----------Contractor's Name--- - Phone / g yoZ Installation will serve: Residence I]( Apo rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--I___ Number of.bedrooms __;L Number of baths j-_-_ Lot size ____ _ _-Aw--------------------------- Wa+er Supply: Public system ❑ . Community system ❑ Private UL Depth to Water Table _Y0 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 ❑ 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---------------------------- -Li uu'0 depth--------------------------Capacity----------------------- i Disposal Field: Distance from nearest well---`X.�_._Distance from foundation—6----_________.Distance to nearest lot line__ Number of lines---------------j------.__--_._ Length of each line---------- . _ Width of trench______--_0-Vpr �� Type of filter material---_�'h_b_L_`.A_-_---Depth of filter material------ length------------- �--------------__-- € 01 &ee} C$it: Distance to nearest _________Distance from foundation___��_______-_-.Distance to nearest lot line__________ ® Number of pits---------]-----------Lining material_gpGK--_----Size: Diameter--- ___+_--------- Depth_-----6___-_______________-__ 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--------------______-________________.._. ❑ Distance to nearest lot line----------------------------------------------- ---------------------- Remodeling and/or repairing (describe):-.------ c" -----_-- ------- ------ --------------------------------------------- F ________________________________ _ cx.. _______-------- -------- ------ --------- _____._-- ___----------------- ------ --- - ---------- -- _ - - -------------------.- .• ------- ----- ` ----------------------------------- 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 rulei and regulations of the San Joaqu' Local Health District. (Signed)_-----�-�_�'-�:�------- - -- +y�- ------ - -------- --------- - ---------------------------(Owner and/or Contractor) ---- ---- --- p By:--_---•--------------------------------- - Z40 -------- -- -- -�--------------------------------(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 APPLICATION ACCEPTED BY----------------------------- DATE ----------------------------------- REVIEWED -------------------------------- REVIEWEDBY------------------------------------------------------ -- - ----- -----------------------------------------• DATE------- BUILDING PERMIT ISSUED..----•-------------------------------- --------------------•--------------------------------------- DATE----------- Alterations.and/or recommendations----------------- - -----------------------------------------------------------------------------------------------------------------------------•------------- --------------------------------•----------------------------------------------------------------------------- ---------- --•-------------------------------------------------------------------•--- -----------=----------------------------------------------------------•--- ------------------- -------------------------------------------------------------- FINAL INSPECTION BY:----------q11_Z2-------------------------------------- Date------------ --`--- -S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore Street 814 Noah "C" Street Stockton, California Lodi, California Manteca, California ,Tracy, California E5-9-2M Revised 1.57 F.P CO.