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APPLICATION FOR SANITATION PERMIT Permit No. v (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 with County Ordinance No.. 5^49. JOB ADDRESS AND LOCATION---------------/.Xis ' 1----L c,�Q r� _12 --------------- l - ------ - ------- -- Owner's Name------- ----10-CII-s rC--+ +` '�� Y J -----/-------------------- c - ------------ ------ Phone- --------------`��_/ Address-----------------_------- Contractor's Name---------- r/E os�•z - --------- ----- -- Phone- z 1 Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other [] Number of living units: __1----- Number of bedrooms __L._ Number of baths __/____ Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(�fardpan ❑ Previous Application Made: Yes E] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- { e Distance from nearest well------_----------Distance from foundation--------------------Material----------- -� J~ No. of compartments--------------------- ----Size----------------------------=---Liquid depth------------------------- -------------------------------------- Capacity ------ Disposal eld: Distance from nearest wellDistance from foundation______-_-________.Distance to nearest lot line----------------- Number of lines---------------L-------------------Length of each line-------$-LP--_f------------Width of french----a Y-__-.--------- ------------ Type of filter material---_�o�.,�-----_Depth of filter materia.l�__-�-d�'-�----Total length-------�-!------------------------ Seepage it: Distance to nearest wall----------------------Distance from foundation---1P_1--------Distance to nearest lot line__$--_x______ \ �f Number of pits---J---------------Lining material_rw4_t-''--------Size: Diameter_3_.3_.-!____ Depth_.....2Q___f______________ Cesspool: Distance from nearest well-________________Distance from foundation------------------- material__._____--_____________.__---------- • ❑ Size: Diameter------ ------------------ ------------Depth----------------------------------------------------Liquid Capacity--------- -----------------gals. Privy: Distance from nearest well-_____________________-_______________________Distance from nearest building � n ❑ Distance to nearest lot line ------ ---------- -- ------------- -- ------------------------------------------�-------------------- -------- ----------------- `\jv� Remodeling and/or repairing (describe)--------------------- ---------------------------------------------- ------------------------------- -•--------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------- P il--- ---------------------------- Jim (Owner and/or Contractor) By: ----------------- ---------- -- r �G� ccs ------ -------(Title)---- Zu ---------------- (Plot plan, showing size of lot tion of system in relation to wells, b ' s, etc.,'can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 1_�_..Q�-------------------- ----------------- ----------------------------- DATE------- r REVIEWED BY -------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------- DATE --------------------------------------------- -- -------------------------------------------- Aterafions and/or recommendati ns--------------------------_____ ------------ ------------------------------- ---- -------------------- •-------•--------•-------------------•-------•----------- , t -P ' fay 1 �_ _� -.--------/'G� -,` —------------------•-------------- -----•-------- ---------- ----- ------------------------------------------------------------- ----------------1�-------------j__A------------------------1-1------------------------------------- _____________________________LO ...______ ---------------- -------------- --------------------------------------------------- - ------------------------------------------------------------------ --- - -------------- -- ------- -- ------- - -------- ------------------------------------------------------------------------------------------- ------------- ----- FINAL fNSPECY __ ____ __ ___ ___ Date....__�Ll.� '_ - - 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 FT.CO.