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APPLICATION FOR SANITATION PERMIT Permit No___&IL�L (Complete in Duplicate) 91 Date Issued ----- Applica+ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein descrVie This application is made in compliance w' ounty Or inance No. 549. JOB ADDRESS AND CA 10 - ---- - ---- ----- --------- ----------------------- Owner's Name----------- - N-- . l I- Phone - Address - el --------------------------------------------------------------g----'--�----0--------------------------------------------------- - Phone.,Contractor's Name .. ---------------- ------------------------------------------------ X1..Z_J' A.7 Installation will serve: Residence a Apartment House E] Commercial [] Trailer Court E] Motel [-] Other Number of bedrooms __�"__ umber of baths _�----- Lot size �2�11 ------ _P��>----------------- 9 ---- Number of living units: --- e --- ------- Water Supply: Public'system LK Community system E] Private E] Depth to Wafer Tablet. Character of soil to a depth of 3 feet: Sand Ej Gravel El Sandy Loam E] Clay Loam [j Clay [_1 Adobe Hardpan E] Previous Application Made: Yes E]. No.U4_ New Construction: Yes No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fanVor cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from,nearesf well_.R1eF*,.4-.Distance from foundation----/ -----------Materi9l----j;f----e, No. of compartments- _�)�- ---------- Liquid depth____ --------------Capacity______- D;sposal Field: Distance from nearest well---1 00�_ 'istance from foundation-----✓f.......Distance to nearest lot line__e�412__ I i:i6;W- Number of lines--------/-------t__A-------------Length-of each line- -.__"Width of french-----cV- - ------------/------ ----- ' --;;:; g5d . T Type of filter maferial__15------��_AiDepfh of filter material-------/../,*----------Total length------- :i-------------;— Seepage Pit: Distance to nearest well-----Awk�-7 D i stance fro foyclafionn-_____-Distance jo nearest lone -------- a dation_ 'A ' I 0F.11 'amefer------ --------Depth-----I;p---------------------- Number of pits-------= -----------Lining.material-_ - --- N� Cesspool: Distance from nearest well------------------Distance from foundation---------------------.Lining material--------------------------- :::gals. El Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity------------------------- Privy: Distance from nearest well------ ---------I------------------------------ --Distance from nearest building.F_______.__._______-------------------- El Distance to nearest lotiline-------------4. ----------------- ----------------------------------I...... -------------------------------------------- ----- ------------ Remodeling and/or repairing (describe):-•-----------------p -----------------------------------------11--------------------------------- ---------------------------------------------------- P ------------------------------------------------------------------------------------------------------------------------------------------------------------^-------------------------------------------------------------------- -------------------------------------------------------------------------------------------------I----------------------------------- -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------1-1--------------------------------------------------------------------------------- ---------------------------------------- I hereby certify hat I have prepared This application and that the work will be done in accordance with San Joaquin County Q ordinances, Stat e'lawil,' and rules and regulations of the San Joaquin Local Health District. -------------------------------------------------------- ------{Own and/or Contractor) (Signed)------------ - -------- ---------------------- ------ ------- ---------------------------- By: --- ------ --- -------- ------------------------------------------(Title)- / - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed om reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- ------------------------ ------------------------- DATE----------_,-f-------------------------------- ------------------------------------- --------------- REVIEWED BY---------------------------------- - --- DATE---- DATE -- ----- ------------ BUILDING PERMIT ISSUED--------------------------------- DATE------- ----------------- ---------------------------- Alterafions and/or recommendations:-------------------- -- ----------------------------------------------------------------- ....... ------------------ --------------- - ---------- -- --------------- - ---- - ----------------------------------- -----------------••-----------------••-- ------L----e----------)��_ - ------------ ---0----1_�_ _ - ,..__--:__:-------------=------ ------------------I-------------------------------------------- _T _ ------------------------------------------------I -------------•------_ --- - --- ---------------------------------------------------------"--.».-_.»---------------------- ---------------------------- --------------------------- ----------------\j----------------------------- ---------------------------------- -------------------------------------------------------------------------------------------------------- Date------ --------------------- FINAL INSPECTION BY::--------5�---------------------------------------------- --- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rS-9-2M . . Revised W2100