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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _175 lication is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. ' a ' '51 is application is made in comp€iance with County Ordinance No. 549. n0 T- 2-00- 39 JOB ADDRESS AND LOCATRO4_'��k:x�_ --- ------ ------------ /Ow Owner's r'.� Name----------- ......4- - -------------------------------------------- ------- Phone 0----� ------------ Address---------- -d .412 Contractor's Name,,JZO.2 �..c,----------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- .Installation will serve: Residence 0 Apartment House [] Commercial 0 Trailer Court [] Motel [] Other 0 Number of living units: /--.--- Number of bedrooms 4-___ Number of baths I-----_ Lot size -4-W-147-f----------------------------------------1*i�7 Water Supply. Public system [] Community system F1 Private R] Depth to Water Table/_0__ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay Loam 0 Clay [-] AdobeiM Hardpan F-l Previous Application Made: Yes E] No 0 New Construction: Yes 1�j No F1 PHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f____ .__ . ' _- r ' (No septic tank or'cesspool permitted if public sewer,is available within 200 feet.) Septic Tank: Distance from nearest well__.S_P-*-----Distance from four�d6tion--- ----------------------------------------- I# ---Al No. of compartments----X------------------Size__?!�7_3 S -----------Liquid depjh__j/--- ---------------Capacity--- ---------------- Disposal Field- Distance from nearest well.4 0_�--- Distance from foundation__-5Z-----------Distance to nearest lot line-47.......... Number of lines--_-teZ--- Length of each line------�0!-----------------Width of trench___,?L_V' -------------------- a Type of filter rn r- -ia_1 -Depth of filter m8ferial__/?_-*-------I---Total length__/A_i?-*--------- ------------- 4 Seepage Pit: Distance to nearest well----------------------Di.sf6nce'frorn foundatio_n---------------------Distance to nearest lot fine--------_------_ �4 ❑ Number ine----------------- Number of pits----------------------Lining material----------------- ---.Size: Diameter-----------------------Depth--------------------------------- , 4 Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.-----------_----_---------------- l ❑ aterial------------------------------------- El Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals.. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__----_.--------__----_--__---_---.-. ❑ uilding------------------------------------------ F-1 Distance to nearest lot line-------------_.--__------ --------------------------------------------------- Remodeling and'/or repairing (describe):--- ^`` ------------------------------------------------- ----------------------I----------------- ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------A------------------------- ---------------------------------------- --------------------------------------------------------w----------------------------------------------------------------------------I------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be—done in'accor4a"nd6-' ith San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---- ---------- ------------------------------------------------------------- (Owner and/or Contractor) By:-----------------------d----------------- -------------- ----------------------------------------------------------------(Title)------ ---------------- ---------------- (Plot plan showing-size of lot, location of system in relation to wells,'buildings, etc., can be placed.on reverse"side). FOR DEPARTMENT USE ONLY • APPLICATION ACCEPTED ------ --------------------------------------------------------------- - � f DATE__f_-_A_9-_- 7� , V- _, I REVIEWEDBY--------------------------------------------- ------------------ ------------------------------------------------------------- DATE------- --------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------- DATE--- ------------------ -------------- Alterations and/or recommendations:- --------------------_----------------------- ---------- ------------------------------ ------------- 1---•--= ------- .... -------- ------------ ----------/V ------ ----------------------------------------------------------------- - ----------------------------------------------------I----------------------------- ------ -------------- --------- --------------------------------------------------------------------------------------- ------------------------------ ----------------------------------------- ----------- --------- ---------------•----- ---------------------------------------------------------------------- e"�fW3 rff_SEEC-T-IO BY: ----------- Date-----9-------------------- - ------------------------------------ ----- 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-7-2M Revisea 1.57 FRCO.