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r? 7 APPLICATION FOR SANITATION PERM40— IT� �� Permit No../.�_�_1__7____.- (Complete in Duplicate) Date Issued 3 --ago --05' Application is hereby made to the San Joaquin Local Health District for r it t nstruct instal the or erein descr+ This application is made incomplian e with County O Hance No. 549,E ret fa L`DS JOB ADDRESS A LOCATION--- o -'T-- # �{ I C -lam -- 41 ' 5------------------------------ 4. �j► Owner's Name--- ---------- ------ D_�yf. D -EIC -7%19 ----------------------------- ----------------------------------------- Phone ------------------------------------ Address ---------- ------- ---- - ----- 1-1-------- -------1 0.. i�5 4.{ M Q? Contractor's Name ---------- 4uJ_fz—--------------------------------------------------------------------------------------- ------ Phone --------------------------- ------- Installation will serve: Residence g- Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __ ---_ Number of bedrooms �.,. � ��x I `-t�z , Number of baths --- (---- Lot size ---------- -------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private JQ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [0[ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'p Yrmitted if publi� sewer is available within 200 feet.) r Septic Tank: Distance from nearest well -%-9Z ------- Distance from fo ncia�ion-._�4_______. $terial__&- ��--- No, of compartments_.__. _- ---------- Size__ _--x_9'�.__:___Liquid depth_ . I-I_________________Capacity _____ �¢ = t Disposal Field: Distance from nearest well-_� ------ Distance from foundati n____i!_Q_______-Distance to nearest to Number of lines ------- _ .__.___ Length of each line --- _�_�-0__----- _Width of french ---\ Type of filter material-__- Depth of filter material ------ 1_g ----------- Total length ------ ------------------------ Seepage Pit: Distance to nearest wel#---------------------- Distance from foundation -------------------- Distance to nearest lot line ----------------- 0 ElNumber of pits ---------------------- Lining material ----------------------- Size: Diameter ______ _______________ Depth --------------------- ----------- 0 - Cesspool: Distance from nearest wef€----------------- Distance from foundation. ------------------- Lining material __________.___.____._------_-_______- r) ❑ Size: Diameter ------------------------------------"De th------------------------------------------•------Liquid Capacity gals. Privy: Distance from nearest well ---------------------------------------------- _.-Distance from nearest building_____-_-_____________"__-___-____________- ❑ Distance to nearest lot. line :_____- Remodeling and/or repairing (describe)___________________ `7 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ` --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- 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, a rules and regulations of the San Joaquin Local Health District. (Signed)--- QQ ---- -- - --- ------------------ ---------------------------------------- (Ow and/or Contractor) B' F --------------------- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be pa don reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ---------------------------------------- DATE--- REVIEWEDBY------------------------------------------------------------------------------------- DATE------" BUILDING PERMIT ISSUED-------------------------------•---------------------------------------------------- DATE Alterations and/or recommendations:-- --------------- ------------------------ ---------------------------------- -------------------------------------------- ------------------------------------------------------------•----------------------------------------------------------- -------------------- ••----------------------- ----------------------------------------------------------------------------•-----------------------------------------------------•--------------•---- ------- ---- - ------------------------------------------------------------------------f-------------------------------------- ----------------------------- FINAL INSPECTION BY- ------------ --- ------------------ Date ------ 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 ES -9-2M Revised 1.57 F-P.CO.