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APPLICATION FOR SANITATION PERMIT Permit No. .../�� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.-549. /V!�V •� J08 ADDRESS AND L �ATCN--------- ------ - - --- iu ---- -=------------------------------------------- ------------------- Owner's Name ------------------------- - -------------------------- Address ----------------------- PhoneGr _= vPd i Address l �•.+Q> 1Q.r � E ---•----- --------------------- --- --------------------- ' • F I E Contractors Name--____-- - -t_ '_------ ------ Phone. - _._ __-- _ �- 6 �7 Installation will serve: Residence Apartment House ❑ Commercial ❑ A Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ c �7 f Number of bedrooms .____ Number of 'oaths _ _____ Lot.si�ze _ __. __�__1��E1Q____________________________ Water Supply: Public system 2--11community system ❑ Private ❑ Depth -to Water Table,9 ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U90 <ardpan.0 Previous Application Made: Yes ❑ No 9K`New Construction: Yes [Gj�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'if public le r is available within 200 feet.) Septic T Distance from nearest wel� stance ��om foun.)ation--/ � _-______________ d ---------------- No. of compartments___�_��____ LL_____-----Liquid depth__�,,lT�.__Capacity_ Disposal ' ld: Distance from nearest well ___ __Distance from foundation-/0-----------Distance to nearest lot line----------------- Number --- -__----_Number of lines------- __ .�_ '_'_--_ ____Length of each line__� --- trench-- ...79_-•. _.____._-__,..__ .� ....De Depth of filter material___ _ �r Type of filter matenaL�3' _ _-- - p ��__._---Notalflength___-___________�C1___.__..-__-_-- E t 4f r% ! Seepage,A'--. Distance to nearest w II - ..-Distanc m f undation-_/sO____-.-.Distance to nearest lot line... -�__.._ Number of pits--------- _�------_.__.Lining material ...Size: Diarneter__.�.. i� Depth_:. Cesspool: Distance from(nearest well-----------------Distance from foundation---.____.___-.-__.Lining material-------!----______--____._____----_ ❑ Size. Diameter------------------ =- - r . Depth-----------------------------------------------------Liquid Capacity ---gals. !: Privy: Distance from nearest well ____________________-----__---.--.-----_--.-Distance from nearest building___._.--_-.-.____--.__----__-.---.__--. ❑ Distance to nearest Sot line---------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- --------------------------------------------------------------------------•----------- -------------------------------•------------------------ --------------------------------------------------------------------------------------------------------------••-------------------------------------------------------------------------------------------------------------- ------------------------------------- ----------------------I------------------------------------------ ---------------------------------------------------------------------------------•---------------------------------- `' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rules an gulations of the San Joaquin Local Health District. r (Signed)___________ __ ___r.._ r______. } _ (Owner and/or Contractor) By:---------------------- ----- -- ---------------------------------------------{Title) (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /f APPLICATION ACCEPTED BY } -------- ----------------------------------------- DATE---- �-f`�--` -•------------------------- REVIEWED BY--------------------------------------------- -------------------------------------------------------------------------------- DATE-------------------------------- -------------------------- BUILDING PERMIT ISSUED----------------- ------------------------------------------------------------------------------------ DATE------------------- ----------------------------------------- Alterations and/or recommendations:--- �_i--.- ---- — -----�s��m-___S✓Ll_��et�Qv�_____�_n_._r�sre -_______lQ._� l�G3+� 'e�1��5- SeLizxr� 0 �'- ru'uL-- -�tn°'r'� •-fi�rkt.Cc - iM C]C --� yf�rG* ------------ C_______________ ---------------------------------- _ __ .___ ----------------------------------------------------------------------------------------------- FINAL INSPECTION BY: ----------------------------- Date I ' — 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 Rev sed 8-'S9P.Cu .ti. -