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APPLICATION FOR SANITATION PERMIT �.Q` Permit No. __ZAJ - -,� (Complete in Duplicate) Date Issued �� O6�r— 2-00--{7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. j This applicatiori is made-in compli nc -wit County Ordinance No. 549. ,4s c.e JOB ADDRESS AND LOCATIO ------�� ✓ . Owner's Name------ �`C A--------------=--------------- Phone Address ------ ----- Contractor's Name ~ J Phone. Installation will serve: Residence P--`Zpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __f-_ Number.of bedrooms-- Number of baths/___ Lot size ---��_�,�.- --•------------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Vaeter Table /, frft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No PRO'� 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,ir---- Distance 7.9m foundation___ __(__ _ Matefi�_-__ 6 __. f - . �. No. of compartments--->�_---------------Sized -_._--Liquid dept---��-------------Capacity---- s -----J., j Disposal Field: Distance from nearest we1L�� _ ___.. Distance from found __ation - __--__Distance to nearest lot line__-�__ ,� -- Number of Imes------'l---------------------- Length of each line_____ ___ Width of trench----- Type of filter material_/i Depth of filter material___/e_____..4-.Total length____ _________ Seepage it: Distance to nearest well---xQr______Distance from f ndation__ .e _____.D' tjj� e to nearest lot line_ ______ Number of pits------- _.________Lining material_/__-Size: Diameter__- - --------------Depth----rtwl--- _____________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- F-1 Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building----.----------------------------___.__._ ❑ Distance to nearest lot line_______________________________ r Remodeling and/or repairing (describe)------------�/ ------J-------------------------------------------------------- --------------------------------------------------- - --- ----------------------------------------------------------- --------------------•--------------------------------------------------•-------------------------------------------•------------------------- --------- 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 regul ions of the San Joaquin Local Health District. -------- ------ - ---- - - --------------------------------------------------------- (OW an ontractor) (Signed)------------------- By:---------------!----------------------•---------- - -- Title-------&,V? (Title) �---------------- (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placeerse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------- DATE----�-'_1 Z-` --------------------------------- tREVIEWED BY------------------------------------------------------ --------------------- ---------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------- ----- - ------------------- ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------- --------------------------------------------------------- --------------------------------------------------------- ------ -------------------------------------- ------------------------------------------------------•-------------------------------------------------•----------- --------------------------------------------------------------------------- I ---------------=-------------------------•--------------..---------------------------------------------•----------------------------------------- ------------------------------------------ --------------------------------------- Date---- �'t' -------------------------------- FINAL INSPECTION- BY----------- ---"-- •------------------- ----- ----------- � � ------------------• - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California R Manteca, California Tracy. California ES-9-2M , Reviseci 1-57 F.P.CQ.