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APPLICATION FOR SANITATION PERMIT�r --.,. Permit No. �p (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 KFance No. 549, JOBADDRESS A L0CATI0"_ Q -_,0t--- - z- --------.---- 4c,64k/------------------------------------------------------------------------- c� .. Phone `-- Owner's NameILQ] { SL -:e '-------------------------------------------------------------------------------------- ----------- -------------------_-- -------------------------- _ .........--------- ---- --------------------- Contractor's CContractor's --------------------------------------------------------------- Phone��_14-7D Installation will serve: Residence 5( Apartment House ❑ Commercial ] TraaIiler Court ❑ Motel E] Other E]Number of living units: --I--__ Number of bedrooms__ Number of Baths -h_-.-- Lot size -- 'A__"____ ___,�_ --_-_-------------- Wafer Supply: Public system 99� Community system ❑ Private ❑ Depth to Water Table -1l_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No(vf_ 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.) Tank: Distance from nearest well- Distance from foundation_f �-----.__-_Material_-_ ''_'___._- ��.-- ------------------ SepticNo. of compartments-.,Q--------------------Size_ !_4C._. &�_ Liquid depth_-- (Pf!.-------_Capacity-__--8__ _r0...........Distance to nearest lot line-----_-- Number ' ... r Disposal Field: Distance from nearest weil_Nby�� _Distance from foundatio _ Number of lines----_Z----------------_..____Length of each line_- , 0-!---�0-l--Width of trench.___4-_44.................... r Type of filter material__.__&V_.---Depth of filter material---(_!;-f-------------Total length------ ------__ w Seepage Pit: Distance to nearest well----i4�-------Distance from foundation__L.4......._...Distance to nearest lot line------2S------_ Q� Number of pits__7--------------Lining material-- -e-J5-------- Size: Diameter_- _ 1----------Depth-----d-4 /-------------- O Cesspool: Distance from nearest well----__-- .-____-Distance from foundation------------------- Lining material------------------------------------- El - -_--❑ Size: Diameter--------.-------------- -------------Depth------------------------------- --------------------Liquid Capacity - -------------------------gals. Privy: Distance from rearest well----------------------------------------------------Distance from nearest building----------------_----------------------- ', ❑ Distance to nearest lot line---------------------------- ---°-------------------------------------- ------------------------------------------------------------------ Remadeli .g nd/ r repai ' escri --- ---- �--- ----- --------- ---------- ---- . -------------------------------------------•------------------------------------------•- ------------------------------------------------ t� �{ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance Sta a rules and re ulations of the oaqu'n L Health s ric+. Y. n..., -r ,..a-ce, �'v u'.rrt L' � gEontractor) � (Signed)-------- --- --------- � --- By:--------------------------------• -•---------------------------------------------------- L. 1~ .-11/91------------------(Title)--------------------------------------------------------------- (Plot ----- ---- i (Plot plan, showing size of lot, location of system in relation wells, buildin�; etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------- I------------------------------------------------------------- DATE-----------qq - -------------------------- REVIEWEDBY------------------------------- - DATE--------- -- ----------------- ------- BUILDINGPERMIT ISSUED-----------------------------------ly- --------------------------------------------------------- DATE------------------------------------------------------------- iAlteration an /or recommenda+ions--------------------------------------------------------------------------------------------------------------------------------------------------------------- 't. -- - ---------------------------------------------_-1-----------------•---•--------------------------------------------------- E ------ --------- -------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- FINAL INSPECTION BY:---------q1_1 _ - Date----- S i. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Straet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revisea 1.57 RP.CO.