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APPLICATION FOR SANITATION PERMIT PermitNO. ._13.2-7- (Complete in Duplicate) Date IssuedfOl�� 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 complian}ce fwith County Ordinance No. 549. JOB ADDRESS AND LOCATION--?--_-!_ � -----------YV� 1t ' L ---___-- Owner's Name-----------C --t--+----- -- ------ ---- Address................................... ---------- Contrai?tor's Name °� ------ ------------------------------------------------------------- -------------------•------------------------ Phone-------------------------------- Installation will-,serve:, Residence [Apartment House ❑ Commercial ❑ Trail Court ❑ Motel ❑ Other ❑ Num'ber'-of=ling units: _--f---- Number of bedrooms __ _ Numberfof ths!�y�,t Lot size __________-------------------------------------------------- Water Sup�ly�blic sys�VCommunity system E] Private ❑ Depth to Water Table _---___. ft* Characterof soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay dobe 1�/ Hardpan ❑ Previous Application Made: Yes E] No R?" New Construction: Yes eNo E] FHA/VA: Yes K No ❑ CA 16.-V hT TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I No- of compartments ... --_ i J p p l-� ---Disf a ---��--•------M terial__4 D.N1- K5 --- Septic ank: '� istance from nearest welll�i!f °�_Distanc�from foundationLi uid de th_.___ _ _ _ - -;Ca aci ��i� +'� _ - ----- ---- Liquid p - - - I! P tv Disposal Feld Distance from nearest well-__ -Pry_-Distance from foundation_ --------Di tan�ce to nearest lot line----t®__-__- Number of lines!_______-q-----------------------Length of each line_ ' -_.Width of trench.____._- __ N 9 y ) 1-------------------- Type of filter material-_RD-C-%e--------Depth of filter material-- - - -----Total length_______ "'—___�� 1 l Seepage Pit: Distance to nearest well_144414_F—Distance from foundation---30._------.Distance to nearest lot line---/V-______ Q Number of pits-1-0-------------Lining material-PV-C--K-----Size: Diameter f Ak-X_.____D ept;$__-q----_-_____-______-----_ Cesspool Distance from nearest well________________Distance from foundation---_------------__-Lining material.k�--_____--___________-__________- ld ❑ d)r Size: Diameter- -=------------------------ --------Depth------------------ ;h'------------------------Liquid Capacity----------------------------gals, Privy: ��Distance, gm. .nearest,well--- --------------- -- -- isiance from nearest buiidin r �� v- ❑ Distance to nearest lot line I------------ --------------- ---------- Remodeling and/or repairing (describe);----------------------------•---------------------------------------------•--------------- 1 -1----------------------------------- -------------------------------------------------------------- -----------------------------------------------------------------------------------=-------------------------------------- 1I -------------------------------------------------------=-------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------•---,-------------------------------------- I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State s, d rules and regulations of the San Joaquin Local Health District. I f (Signed)----------- `.,.�. ------- -- ------ {Owner and/or Contractor) By:---------------- - ------------------------------------------------------------- (Title -----------------------1------------- ------------------------ (Plot plan, showing si a of lot, location of system in relation to wells, buildings, etc., can be placed on reve sr a side). FUWDEPARfME' NT USE ONLY # APPLICATION ACCEPTED By----------- ----------------------------------------------------------------- DATE----------��----.�- '�--�- ---------------------- �.. REVIEWED BY-----------i---------------------------------------------------- ------ DATE---------------- - - ------------------------------------------------ -- -- ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------- Alterations and/or recommendations---------------------------------- --------------------------------,I!., ir-----. -------- 'A�Y-------------ft--------�------a---------------O.K.-----r--K. ------------------ -------------------------------------------------------------- •------------------------------------------------------------------------------------------------------------------------------------------------------------- L ------------------------------------------------------ -----7----------- ---. -- - ----------------[ ------------------------------------------- - I � _ FINAL INSPECTI'O-r -B --r--- --------------- --- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT d° i30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California ES-9-2M : Revisea 1.57 FY.CO.