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� 7 & APPLICATION FOR SANITATION PERMIT Permit No. f_______________ in Duplicate) t S (Complete p } Date Issued _____A/�� Applica{ion 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. 649. Lot lbilkersc?n_-Manor-----••--------------p_ "-03C)--0 JOB ADDRESS AND LOCATION_____________________-________ -:-------. - - Owner's Name-------------Fl-Ov-d---&__Ai1ke_Y'sori--------------------------------------------------------------- --------------- Phone----------------------- Address-•---•------------------•:-••---------------------------•-------------------____----------•---------------=----_------------------------------------------------------------------------------ -------------- Contractor's Name &b04E- --------------------------------------------- Phone.. Installation will server Residence[ Apartment House❑ Commercial ❑ Traer Court ❑ Motel ❑ Other ❑ ' s Number of living units: __�___ Number of bedrooms _c ,r Number of baths ---__.__ Lot size ___ /! Water Supply: Public system ❑ Community system 52"0'Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes &1-'No ❑ New Construction: Yes ENo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well-----°''------Distance from foundation_ _____ Mate 'al __ r �� Ca acit No. of compartments---- �i[�°_.- - ---Sizer.. --- Liquid eptly----------- P Y , � Disposal Field: Distance from nearest wefi.___-_I---..:Distance from found t -ion__--�_�_-Distance to nearest lot line.4. ----------- 01' ------- Number of lines__ ____ __---_R___ _ Len th of each line _ Width of trench..____.____ - '�"'� - - ------•-- g j---- �-�------------ � Type of filter materi�"_if ----Depth of filter material"_ __, ____Total length_______ t____________________ Seepage Pit: Distance to nearest well._ ____ Distance from foundation___________________.Distance to nearest lot line------------------ � ] Number of pits----------------------Lining material --------------------:Size: Diameter----------------- Depth r5 a . 'Cesspool: Distance from nearest well_________________Distan e from foundation_._"________-_-__lining material-__.-__-___________-_- ----__ ❑ Size: Diameter--------------------------------------Death----I-;-----------•-------------------------------Liquid Capacity-- -------------------- gals. " Priv Distance from nearest well----------------------------- _______________Distance from nearest building------------------------------------------ ----------- El ____________-------__________-_________- { Y��° _ ❑ Distance to nearest lot line__________________„ r: = ----------- Remodeling and/or repairing (describe}:--------- ---------_-------------- -- -• ---------•---------------------------------•-•---------------------•-•--------"-----------.----------•----------------------------------------------------------------------------------------------------- ------------- •f I hereby certify that I have prepar d this pplicat' n and`that the work will be done in accordance with San Joaquin County ordinances, Stat s, rtl_, egul tuns of San Joaquin Local Health District. (Signed ., _--.-___(Owner and/or Contractor) F -------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system" in relation to wells, buildings, etc:; can be placed on reverse side). f FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY' .'----------------------- ----------------------- ----------------------------------------- DATE ---- - --- ------ -- REVIEWEDBY-------------------------- -=------------------ ---------------------------------- ---------------------------------------- DATE_ *_.._ ---------- BUILDING ------ BUILDINGPERMIT ISSUED_.FA---------------- - --------------•---•-------------------------------------------------• DATE-- ----- ------ Alterations and/or recommendations:-- - ---- ----------•- -------- ----------"--------•-----------•-----------------•----•--------------- •--•-------•---------------------------- _____________________ ________________________________________________________________------------------------_------------------------------ ___________________________________ _ ______________________________________________________________________________ ------------------------------------- ------------------------- ------ - + ________________________ j ___________________ti__'s__ ________________ ____________________________________________________________________________ _---------------- 5" _______________T7 FINAL INSPECTION BY------------------------- -------- Date----.. g ------------------ - ------------------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Fc—o—,)u ; - Revised W-2100