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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application 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 County Ordinance No. 549. JOB ADDRESS AND L C TION----- --_p __ ! � r2•-- ��s Owner's ION----- Owner's Name ......... _ry,. - Address-------------------_ --------------- Phone Contractor's Name_.. ----- ..7---------------------- --- Installation will serve: Residence -------------------------- ------------------------------------------------------------------------------------:. Phone 00"'-Apartmerif House Ej Commercial Number of living units: El Trailer Court E] Motel ❑ Other ❑ I---- Number of bedrooms 3---- Number of baths ;;;n Lot size __K ' 5�._� Wafer Supply: Public system [] Community system E] Private e Depth to Water-T bez 11_ff, 2� [I Adobe Ej Hardpan 0 Character of soil to a depth of 3 feet: Sand [I Gravel E] Sandy Loam 0 Clay Loam a I y Previous Applicaflon Made. Yes El No P----New Construction: Yes 2_---NO ❑Ej FHA/VA: Yes E:1 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 weil,56' Distance from fcunclafione?�� No. of compartments---02-------- ----�MaferialC-------------- ------- • ---Liquid depth < -------------- Disposal Field: Distance from nearest well 50 ------ ---------Capacifyz ------------ Number of lines- ----- -jim�Disfance from �ounclafion,2A -Distance to nearest lot lipe__12 ------------------------Length of each line-,-7- ----------------- Width of fren,h------ Type Of filter material-S-)-jA?A_ek----Depth of filter material----/- -------- •------------•-- Seepage ----------Total length______- _____- ength------;2-:Z Z� Pit: Distance to nearest well___________-_- Distance from foundation-------------------Distance to nearest ]of line-, El Number of pits.--------------_-----Lining material-----------------------Size: Diameter----------------------Depth----- ------------------------- Cesspool: Distance from nearest weif-----------------Distance from foundation.___--__-_ E-l Size: Diameter------------------ -------------------Depth------------------------------- ---------Lining material___-_.___--------------------------- Privy: D;sfarce from nearest well----------------------- .....................Liquid Capacity-.--------------------------gals, r_1 Distance to nearest lot line___---------------- ------------------------Distance from nearest building------------------------------- Remodeling and/or repairing (describe):-__-__--------------- ........................................ ------------------------------I----------------------------------------------------------------------------I----------------------------I------------ ---------- ------ ........ --------------I--------I--------------------------------------------- ----------------------------------------------------------- -----------------------------------------------I----------------------------------------------------------- ------------------------------------------------------------------------------------------- -------- ------------------------------- --------------------------------------------------------------------------I----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ty By:------------------size --------------------------------------------------------------(Owner and/or Contractor) (Plot plan, showing si --------------------------------- --------- -, can be placed on reverse side).--------------------------- Ze of lot, location of system in relation to wells, buildings, etc (Title)---------------------------- K MWAVIV19P By_ L'CAT'O'NA ACCEPTED W By .. ..... VL78 %1 2; v, ,FOR DEP �T USE 0 APPLICATION ACCEPTED BY------ REVIEWED BY---------------- 1-00--- — DATE----- -- -------- ------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------------------------- DATE DATE s:-------- -7 ------------- Alterations and/or recommendation -------------------------------------------- , .................................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------- .................................... --------------------------- ---------I------------------------------------------------------ ----------------------------------------------------------------------------------------------------------I------------------ ------------------------------------------- ---------------------- -----------------------------------------------------------------------------I-------------------------------------------------------------------- ------------------------------------------- -------------- ------------------------------------ ---------------------------11------------- ------- ----------------------- ------ ---------------------- FINAL ---------------------- INSPECTION BY: -------------------------------- -------------- Date---- '4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Stockton, CaliforniaSycamore Street 814 North "C" Street Lod;, California Manteca, California Tracy, California ES-9-2M Revisal 1-57 F,PrCo.