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APPLICATION FOR SANITATION PERMIT 41i Permit No. -------- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. cat'i d application made in compliance with County Ordinance No. 549. JOB ADDRESS AND6 ------- --- ------------- ------------------------- 3P --- Owner's Name_______ ''0ATION-........... k_�p—--------------------------------------------------------- Phone. -----------r-_6,Lee_-x�_ Address----------------4Z.§�_ ...... ------------------------------------------------------------- ----------------- ---ye_1_ 4� Contractor's Name.------5_49__� -- --- ---- ----------6— -1-------------------------------------------- Phone.,'d��----L/0---- Installation will serve: Residence �-Aparfment House E] Commercial 0 Trailer Court [] Motel 0 Other E] Number of living units: j--- Number of bedrooms —5—'- Number of bafhsP,--- Lot size ----------------- Water Supply: Public system E] Community system FtL Private E] Depth to Wafer Table Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan Previous Application Made, Yes E] No tA_ New Construction: Yes Ja No 0 FHA/VA: Yes;g— No E] TYPE OF INSTALLATION AND SPECIFICATIONS: *11. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 4�_' Distance from foundation---!f�-------.Material---- ------------------------------ No. of compartments---- ------- Liquid depth___ Z-----------Capacity__,e_&'7)------ Disposal Field: Distance from nearest Distance from foundation---Ap---------.Disfance to nearest lot line ne ---------------- Number of lines____________---_,----------Length of each line-----------;7-4-D�_,- --.Width of trench-.-- ------------------- Type of filter material----/J�-------!�kDept?i of filter material-------/_3---------Total length-----/:�� f�! Seepage Pit: Distance to nearest well,_�Z�-Iv---------Distance from foundation_____4-?-_-'-._/_..Distance t6 nearest lot line___`-__________- 7 1Z. Number of pits--------c;?--------Lining maferial__/?Z�. _Size: Diameter_, __S_'_" Depth___.__-- -_______-___.__ Cesspool: Distance from nearest well_________________Distance from foundation.-.._..__-__._-_--_ Lining maferial-------------------------------------- 0 Size: Diameter- ----------------------------Depth------- --------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------- -------Distance from nearest buil&ng----------------------------------------- ❑ Distance to nearest lot line------ -- ----------------- ----------------------------------t------------------------------------ Remodeling and/or repairing (Jescrlbe):---------------------------------------------------------------------------------------------------------------------- ------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------•-------------------------------------------------------- ------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have Prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-i iiw . and rules and regulations of the San Jp.aquin Local Health District. 9-W (Signed)----- - -- --- -- ------ ---- -------- ---- -------------- --------- -------------------- (0 nor and/or Contractor) - --- --- ---- (Title} ------------------------------------ ------------- ----- ---------------- _____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ----- ---- -------------------------------------------------- DATE---------N REVIEWEDBY---------------------------------------------------------- ----- ---------------------------------------------------------- DATE------ BUILDING ATE------- ----- ------------------------------ BUILDING PERMIT ISSUED---------------------------------- --------------------------------------------- DATE--------- ...15:�--------------------------------- Alterations and/or recommendations:---------- --------------------- - ------------ ------------------------------------------------------------------- ----- -------------- ------------------- ------ ......... -------- -- -------I--------- 4�- ----------- ----------- • ----------- -------------- ------- --------------- --- - - ------------e------IQ. Tb__ ---------------- io- ._----------------- -- ------------------------------ ------------------------ --- -------- -------------------------- ---- ------ ------------------- ----------- --------------------------- ----------------------------------------------------I--------------I------- ---------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:------(a•4------------------------------- Date.....4---------;&b--------�77----------------------------------- 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 Revisea 1.57 F,P-CO,