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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) -� . .-. • Date Issued X7��-- _...�, Z2-`f�a23-r2� Application is hereby made to the San'Joaquin Local Health District for a permit to construct and ins7A� rein described. This application is made in with County Ordinance No. 549. JOB ADDRESS AND LOCATION i ... _ . e --------------- Owner's Name---------------------- rat_ - - -: -=-- ;::- . __.-. Ph ----•-----• one Address---_--------------- �_ r------- -------- --- ----------------- Contractor's Name____________________ --- --------- ------------- ---- ______= _ a __ ___ _ _ Pone.---••--••---• ---------•---------• Installation will serve: ResidenceApartment House ❑ Commercial IerrCourt ❑ Motel ❑ Other ❑ Number of Evin units:--/.-- Number of bedrooms ' ¢ g .3_-_ Number of baths __� Lot size ater•Supply: Public system ❑ 'Comm uriity"system ❑ Private.® Depth to'WaterTable-1ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ' New Construction: Yes' o ❑ FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:r ' - i - (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 00Septic Tank: Distance from nearest,ww ell7©-�---___Distance from-foundations .Ma rial____ i I9 No. of compartmenfs_�_--:2-`1---_-----Size_fA��_ _ •__Liquid depth--- _�--- Capacity...'16 Disposal Field: Distance from nearest well-._ �__ / "»s• .Distance to nearest lot line__--:1� !-4� -___ -_.Distance from foundation_/d Number of lines----------�-_� Length of each line--- --------- ------Width of trench__p�- --�'--------------- �.- Type of filter material_ __l�< - epth of filter material-----��------__Total length...../•-O Seepage Pit: Distance to nearest well____-___---._-___-___Distance"from foundation.....................Distance to nearest lot line----------------- . ❑ Number of pits----------------------Lining material-------------- --------Size: Diameter------------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------!,_-__.Lining material--------- :__°___.-_..__-__________-. ❑ Size: .Diameter--------------------------------------Depth---=--------------------------. ------------ -------Liquid Capacity--------:--•----- ---------gals. Privy: Distance from nearest well________________ _ ________ _ '_-,_--_____---._-_-.-Distance from nearest buildin { g ❑ Distance to nearest lot line- ----'------- -----=------ '=----==-----�-----------=----=----•_=- - r _ Remodeling and/orrepairing (describe):--------------- ---------------------------------------=-•-------- ----- f _ -----------------------------r -----------------------------------------------------------•--------•------- ----- -- •---------------- --------------•--------------•-------------------------------------------------------'-=---------------• -----•---------------------------------------------- - I-hereby certify that I have-prepared this:application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �. L(Signed)- -----------------�: � - - - Owner and/or Contractor)... B - ------------ F - -- R -------------------•-------------------------------------•----------------(Title)---••--------- - ------ Plot plan, showing size of lot, location of system' in relation to wells, buildings, etc., can be placed on reverse side). ; D PA ENT U W ONLY l APPLICATION ACCEPTED BY-------- - -,.-- ------ ----- - -- - DATE------- - •------ REVIEWED BY ---•------------------ __ BUILDING PERMIT ISSUED ------ DATE---------------------- - --- - Altera ions and or r comma' atio :_ --------------------------------- --•----- --` -.,,, - -----1s-_-,;.� _f__-�--= --------- - •- ---•-- -••-------- ----------------- ---------- -------------------------; ---------------------------- FINAL INSPECTION -------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street f32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revisea 1-57 F.P,CO-