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I 11 APPLICXTION FOR SANITATION-PERMIT Permif No. (Complete in Duplicate rz Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the rk h rel' des ribed. This application is made in complianceswith County Ordina ce No. 5 r+ r �? �r� JOB ADDRESS AND L CATI /! ---�--ice-- o Owner s Name"_ �/// ----- - ._. �.��p!,=-�_ " - _ ^._ - - ----------- -------- '� • Address--------- � --- ---------------------------------- ---- Phone. Name-- -- ---- •-------- ------- ------------- _-.---------------------- Contractor's ! ❑------------ --- E Installation will serve: Residence�PrApa—r#e t Hourt se Commercial - " Phone--------------------__----------- r ❑ Trader Court ❑ Mgtel ❑ O h Number of living unitser+❑ : _-1Number of bedrooms 1) ' � Number of baths _�"" Lot size _"p"{p•�-__� � ` Water SuAP Y�l Public s sfiem Communitystem Y ❑ system ❑ 'Private Depth to Water Table ----- ft. Character of soil to a depth of.3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Cla Previous Application Made: Ys No Y.❑ Adobe ardpan ❑ r ❑ New Construction: ,Yes, ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pyla Vc sewer is available within 200 fee}' Septic nk: Distance fro m nearest wel0Q� Wl--�-- Drstan fr fo ndatron_-�a---- .Mater"alb I No, of co n• X/ 'r��x r "--'--- rze Liquid- iepth____--- ---------- Ca Capacity_ ^ Dis71, os 'Field: Distance from nearest welIV_"_"_ Distance from foundation.___ p yQ Number of lines_____ -- 'Distance to nearest lot I'ne_ �""'' Lengfh of,ea line__-_ r___ -Width of trench----- - L{f__ ,E+ Type of filter materi � � �_Q---- r �'-`''Depth of filter material-------f-9__ Total length----------- �'Q_________________ Seepage Pit: Distance to nearest well __.-_""_Distance from founds on_________" Distance to nearest lot line_____-"-"-"-" �. ❑ Number of pits-----------""-- "---Linin material_' ""--_`-- --_"--- Size: Diameter ----------Depth---------- Cesspool: Distance from nearest well----------------- "" -- Distance,from! oundation._____-"______----.Lining material----- ""_""-""" ❑ Size: Diameter_____. --" --- - -- Depth--------- -- ------ f Liquid Capacity_ ----------gals. '��Privy: Distance from nearest well_____ ---""" ----------- ------Distance from nearest buildin ❑ Distance to nearest lot line--------------"----- g 4'-`•- _ t i •--------- Remooling9and/or repairirr dbsrribe)---------------------"- " � -------------------- _ --- -- ------ '`� l I -- - -------------- ----- - - -• -------- ----- ---------------------------------------------------- ( f ------------------------------------ ----- I hereby certify that I have prepared this application and that fhe`work will be done in accordance wifh San Joaquin County ordinances, State laws, and rules and tegulations of the San Joaquin Local Health District. { (Signed)------ -- ; -------------------• ---------- Owner and/or Contractor) By:-------- ---------------------------== (Title) (Piot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - -----"-"-" rn ---------------------------------------------------------- --------------------• — REVIEWED BY -------------- DATE--7;.-,, . BUILDING PERMIT ISSUED_ ` - - --------- DATE---- Al+erafions and/or re commendafions: ---------------------------- - ---------•-�;-------•--•---•--• - ----- -- ------�=!k)------ ��r`�- " - '-•--.- -__�-��_�----------------- - 4., -------------- ------------------------ -------------------------------------------- - ---------- ---------------- FINAL INSPECTION BY:_. '�Fs� Date L'' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore 5freet 814 North "C" Strait Stockton, California Lodi, California Manteca, California Treey, California E5-4-2M , Revised 1.57 F,P,CO.