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�( APPLICATION F011 SANITATION PERMIT Permit No. ____J-11----°Z•l- (Y' ,,'.�� Com tete in-Du licate { p p ] Date Issued �- t Application is hereby made tothe San Joaquin Local Health District for a.permit to construct and install the work herein described. This application is made in compliance with County finance No. 549. P i 44-946 � j JOB ADDRESS A# LOCAThO _ -`-'4-9 4`� - - ---f)_�<��L. z--1--------------------------------------------------------------- {�-------7----- n A Ownersme_ � ------------------------------------------- Phone- Na ---- 4 y`' t ------------------------------------------ I- � 2 ----------------�---•-------- Address--------------- s Phone----------------------------------- Contractor..s0Nam ----------------------- =° Installation will serve: Residence &3/Apartment'House.i❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___._ Number of bedrooms -3. Number of baths ---I---- Lot size --_�� - - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table - ft• I Character of soil to a depth o3 feet� San E] Gravel E] Sandy Loam ❑ Clay Loam ElClay E] Adobe 0- Hardpan ❑ Previous Application Made: Yes 0 No JS:, New Construction: Yes ®�No .❑I PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPErCIFICATIONS' (No septic tank or'cesspool permitted if public(sewer is available within 200,feet.]f f a Materia fry �I= ------ --- ---- -- -------- Septic Tank: Distance from nearest well__��__.--Disce from foundation__-_---__ z �. No. of compartments -- �-----------Siz __ .�5 +;r Ligwd depth---- Capacity.. I Q-.........Distance to nearest lot __. line_ -57..__ Disposal Field: Distance from nearest well----- _.._.Distance from founidation•____� Number of;lines-_ _- n__-_-_--Length o a ch line--------- ---_ Width of trench-----�__--_- Type of filter material__-________.L ---Depth of filter material _-I_V$------------Total length-----2—q-.Q------------------------ , Seepage 9e Pit: Distance to _ p nearest well---------------------- from foundation--------------------Distance to nearest lot line_________________ �) ❑ Number of pits.,! ------------ Lining material�-------(I---------i----Size: Diameter-----------------------Depth- ------------------------------- Cesspool: -------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------- material------------------------------------ I 6\ ❑ Depth _1, --_ E I Li uid Ca acit els. Size: Diameter----------- ------ ---- -------- ---'--------- ---`----------------- q p Y --------------- ------•g ( "I Privy: Distance from nearest well-______-------------_-_--�_-T___{._____-_ _-Distance from nearest building________________-_________________- ❑ Distance to nearest lot line------------------------- -- -------•--------------------------- f + I 11VRemodeling and/or repairing (describe)-------------------------- r ---- ---------------------- I 4 ------------------------------------------------------- ----- -------------- ------•------------------ • - 1 I I 1 ---------=-------•----•-- - -------------- --------•---------------- L , i ° I --------------------- ------ -----------------------i-•------- -------------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that,the work will be done in accordance with San Joaquin County ordinances, St a laws, a rules and reguI o L-of the San Joaquin Local Health District. 1 1- ------------------------(Owner and/or Contractor) (Signed)_ - ypV--- - ----------------------- ( -------------------------------------------------------- ---------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY----------------------- ---•---------------------- DATE---------- -- - ----------- IDATE------ --------------------------------- REVIEWEDBY----- ---------- --------�----- �------------ - -- - - - - ---- ---------- ----------------------------- BUILDING PERMIT ISSUED----- ------- ------ - ---- DATE Alterations and/or recommendations:--------=---------------------------- -------------------------------------------- -------------,---------------- -------------------------- --_-_-__ --- --------------------�-____-___ ---------------------- °�' * � -------------I------ ---------------------•------------------------------------------------------------------------------------------------------------ I --------------- --------------------------------------- , ` k I Date---! 7--- •------------- FINAL INSPECTION BY:, - ---- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t Lodi, California Manteca, California Tracy, California Stockton, California I ES-9-2M , Revised 1.57 F.P.CO. ��