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APPLICATION FOR SANITATION PERMIT Permit No. -- (Complste in Duplicate) 8` 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 Ord' ante No. 549. ©(� 4.9* cc11a.� j Z f i 1 JOB ADDRESS AND LO'C/ATION------------ -- -- -------- -- - _�X-c-r/s_ Owner's Name-----------=--/ _ ' "L / ( _ U'�G/a'� "" Phone 1 ---- - Address- ------------------—- ----------- ------------------------------------ - w - �*I` --------- F. ContractorsName ==----•------------••--------------------------------------------------`- :_:�- ------------------------ ---- r Phone------- -----�---------------- Installation will serve:'- Residence ❑ (Apartment House ❑ C%m'mercial [] Trailer Court ❑ tFI ❑ Other JW �l of PP Y� living ❑ . Community system ---Private Depth� ------ Lot size ------------------- •--------:.y------3---------------- Water Supply: Public system Number of bedrooms _ Number f bathto Water Table ________ ft. Y Y Y ❑ ❑ Character of soil toa depth of 3 feet: Sand E] Gravel E] Sandy 1o`am ❑Clay Loam Clay E] ' Adobe E3 Hardpan ❑ Previous Application Made: YerE] No 9- New Construction: Yes ❑ No PHA/VA: Yes ❑ No � a� .010 TYPE OF INSTALLATIONAND-SPECIFICATIONS: (No septic tank'!or'cessp'ool permitted if public sewer is available within 200 feet.) � Septic Tank: Distance + frohnearest well_________r_'__-___-__"_SDiizstan.cae from_lou4n ation______ . Meara , _____-___ ____i.____________.___ �,.__ No. of com arfinenfts_ Liuid dth_ -_-Ca ac3# � Y Disposal Field: Distance frorriinearesf well__-'-__-__-Distatce from foundation----r_____----.Distanre folnearest lot line_______________ lz)l A,. i Number of lines_____ ______,______ , -_- Length of each lines_ _ _'�Widthrof french__________ L�3___ ____ 1 Type of filter material____ '___ ____Depfih' of filter�materi�� 4-__}To}al length_____________________--______ N. Seepage Pit: Distance to nearest wff-------------------Distance from foundation-----------------.._.Distanc!eto nearest loft line----------------- . ❑ Number o pits------------ " . __--Lining material-------- ,---Size: Diameter- _-,-- _--- Depth -Cesspool: Distance from nearest well _____Distance fromlfoundafion, Lining material-------------------------------------- ❑ 5i{e: Diameter_-- �-__� ---- Depth #--------------------------I--------- Liquid Capacity ----gals. - L � Priv Y Distance from. nearest wellDistance�from near es ''building ❑ , Distance to nearest lodline----------i--------------oe,---�------------------------- --------��=:-----�--f�--------------------------- -- - x Remodelin and/or repairing (descriUe)= ;-- :. --------------------------�------------- - - T -.._ _.- • . --------------------------- --___- .. ---------- = ---- -- -- ------------------- N i *# -='--- . --------------------------- - -- --------------------------------------- I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County , ordinances, Std laws, and rules and regulations of the San Joaquin Local Health�District. -}Signed} ------- ------------------= actor)_ --_ I wner ar•Contr B .......................... -----------------------------------------� ----- -- L--------------------------(Title)--------------------- --------------------------------------- (Piot plan, showing size.of lot, location of system in relation to we1106uildings, etc., can be' laced on reverse side). y FOR DEPARTMENT�USE ONLY APPLICATION ACCEPTED BY �Ai------------------------------- DATE--------- ------------------------ --- --- ---------------- ------------- ------ ----- DATE---- --- REVIEWED BY BUILDING PERMIT ISSUED----------------------- ----------------------- --------------------------------------------------- DATE----- Alterations nd/or recommendations----------------------------------•-----------•------------------------------ --------• ------------------------- ----------------------------------------------- ---- ----------Y, ------r--------------------------------------- ------------------------------------------------------------- --------------------------------------------I--------------- -------------------------------------- -----------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- r X11/ FINAL INSPECTION BY Date-.5- ate . ---------------J--- --------------------------------------------- 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 F,P,CO. I