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,A,A�` APPLICATION FOR SANITATION PERMIT Permit No_//_5- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit o c nstry f and install the work herein described. This application is made in compliance with County Ordinance 9. 017 (Q 0 JOB ADDRESS AND C ON -------------- ----- ----------- - --- oto-4 Owner's Name------ ..... ------- --- --- -- ------- -------------- /�/ --- hon - ------------------------------------- Address------------------- --------- --------- -------el--- -------------- ------------------- ------------ --------- ---- ----- Contractor's Name__________________________ • -- ---------Zffc------- ---------------------------------------------- P ne----------------------------------- Installation will serve: Residence M Apart'menf House ❑ Commercia E] Trailer Court F] Other E] Number of living units'`: Number of bedrooms Number of baths -I'- Lot size ---/6_Q__ ---f,, r---------- -----------Water Supply. Public system Community system El Private F1 Depth to Water Table-S1?_ ft. ,Character of soil to a depth of 3 fee+: Sand E] Gravel F] Sandy Loam Ej [j ay Loam Clay 0 Adobe Hardpan 0 iYes El Previous Application Made: No 5( New Construction: Yes E] NFHA/VA:-Yes ❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 1� 1�Septic Tank: Irl Distance from nearest well--______________Distance from foundation--:-----------------Material------------------------------------------------- %%f"v No. of compartments--------------------- ----Size------------------------.------.Liquid depth--------------------------Capacity--------------------- Disposal Field: A/ Disfance;l:from nearest well_________________Distance from foundation--------------------Distance to nearest lot line______-___--____. OffYUi �(S 7-1 Number.'�f lines-----------------------------------Length Length of each line------------------------------Width of trench------------_---------------------- Type of filter material---------- Depth of filter material-----------------------Total length_-___--.--___-_-----__------__--____-___-- /----------- 0. Seepage Pit: Distancelto nearest well----/V_V 4�---DistancEP-4om founclation--AW---*-------Distance to nearest lot line-./r_-_--_-- Number ine-./r-------- Number of pits----4--- -------Lining Diameter__.�U__//----------Dept ------------------- Cesspool: Distance]'from nearest well-----------------Distance from foundation-------------- -----Lining material__.__.___-___-.___------_---_-___--_ 0 Size: Diameter--------------------------------------Depth------r------------------------- ------------------Liquid Capacity----------------------------gals. Privy: Disfarice'lfrorn nearest well-------------7----------------------------------Distance from nearest buikding------------------------------------------ F1Disfance'jo nearest lot line---- - ------------------------------------------------------------------------------------------------------------------------------------- 1� - Remodeling and or repairin (describe)-------- describe):------ ------- --------- -- ----Kc --------- ------------------------------------------------------- ------ ---------------------------------------------------- ---------------------------------- --------------------------•--------- -------------------------------------------------------------------------------------------------------I---------------------------- --- -------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I certify that I 16.) pared this application and that the-w-o- will be done in accordance with San Joaquin County 'n d rule L ordina c s fate la's, d les gulations San I Health a allith ricf. Joaquin OZ ----- ---------- - - -------- -- -------------------- -(Owner and/or Contractor) (Signe ----- ------ ---- ------------- ----------------- ------------ By:-------------------------------------------------------------------------- ---------- ---------------------------------------------(Title)- (Plot plan, showing size of loi, location of system in relation to wells, buildings, etc., can be plakeon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------------------------------------------------------------- DATE----- 57------------------------ REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- men'dations, --------------------------------------------------------------------------- Alterations, nd/or ecom ----------------------------------- ----------- ------ ----------------------------------------------------------------------------------------- ----------------- ---------- ------- ------------------------------- ------ -!s, — 'r ---- ----- -------------------------------------- ------------------------------------------------ ------------------- ---- -- ------------- ---------------------------------------- 7 -------------------- -------------------------- ------------ ----- :��---------- ---------- 7-��_ _ ---------- FINAL INSPECTION BY— D t ---------------- SAN JOi,<QUIN LOCAL REALTK DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California FLodi, California Manteca, California Tracy, California ES-9-2M Royiso6 1.57 F.P,CO.